Decision-Making and Interventions During Interfacility Transport of High Acuity Patients with SARS-CoV-2 infection

Troncoso, Ruben D.; Garfinkel, Eric M.; Leon, David; Lopez, Sandra M.; Lin, Andrew; Jones, Dennis; Trautman, Shawn; Levy, Matthew J.; Margolis, Asa M.

Introduction There is limited data regarding the typical characteristics of COVID-19 patients requiring interfacility transport or the clinical capabilities of the out-of-hospital transport clinicians required to provide safe transport. The objective of this study is to provide epidemiologic data and highlight the clinical skill set and decision-making needed to transport critically ill COVID-19 patients. Methods A retrospective chart review of Persons Under Investigation for COVID-19 transported during the first six months of the pandemic by Johns Hopkins Lifeline was performed. Patients who required interfacility transport and tested positive for SARS-CoV-2 RNA by PCR assay were included in the analysis. Results Sixty-eight patients (25.4%) required vasopressor support, 35 patients (13.1%) were pharmacologically paralyzed, 15 (5.60%) were prone, and one (0.75%) was receiving an inhaled pulmonary vasodilator. At least one ventilator setting change occurred for 59 patients (22.0%) and ventilation mode was changed for 11 patients (4.10%) during transport. Conclusions The safe transport of critically ill patients with COVID-19 requires experience with vasopressors, paralytic medications, inhaled vasodilators, prone positioning, and ventilator management. The frequency of initiated critical interventions and ventilator adjustments underscores the tenuous nature of these patients and highlights the importance of transport clinician reassessment, critical thinking and decision-making.