Canadian Journal of Anesthesia, Vol 35, 303-308, Copyright © 1988 by Canadian Anesthesiologists' Society

ARTICLES

Physician-accompanied transport of surgical intensive care patients

MJ Girotti, G Pagliarello, TR Todd, W Demajo, J Cain, P Walker and A Patterson
Department of Surgery, Toronto General Hospital, Ontario.

During a one-year period, 107 critically ill adult patients were transferred by a physician-accompanied transport system (PATS). Most patients required both tracheal intubation (82 per cent) and mechanical ventilation (71 per cent), while continuous vasopressor support was required in 27 per cent of transfers. Patients were classified as either potential organ donors (n = 21) or nondonor patients (n = 86). Nondonor patients had a mean time of patient transfer documented from the initial telephone contact to final arrival of the patient in the ICU of 345 +/- 221 min (range 65-1350 min); the mean time the patients were out-of-hospital was 73 +/- 58 min (range 5-330 min); the average distance travelled by the patient and PATS was 342 +/- 692 km (range 1-4000 km). Ultimate nonsurvivors of ICU admission (36 per cent) had shorter out-of-hospital times, shorter travel distances, and increased interventional support, as assessed by the Therapeutic Intervention Scoring System applied over the telephone and prior to departure at the referring hospital. Significant interventions were undertaken by PATS in 23 per cent of the nondonor patients prior to departure. During the transport process, there was at least a seven per cent morbidity (arrhythmia, hypotension, and vehicular difficulties) and a 0.9 mortality rate. We conclude that PATS offered significant advantages to this patient population through its ability to maintain acceptable morbidity and mortality rates while transferring patients over long distances and for prolonged periods of time.