ABSTRACT 809

Abstract

Background and aims: Transporting critically ill children to tertiary centres capable of providing intensive care is the mainstay of pediatric emergency transportation services worldwide. Conversely, where state of the art life-sustaining interventions fail to improve outcomes and when medical futility is reached, the transfer of such patients to their homes for comfort and palliative care is seldom described in medical literature. Our Children’s Hospital Emergency Transport Service (CHETS) is a dedicated neonatal and pediatric critical care transport service established in 2004 and on average performs 90 missions annually. Our intensivists offer families palliative transfers home as part of end-of-life discussions. Aims: We report our 10 year paediatric palliative transport experience. Methods: We performed a retrospective audit of CHETS records from 2004 to 2013. Results: Eight local palliative transfers were carried out within this period. Median age of patients was 6 years (range 11 days to 14 years). Diagnoses included complex congenital cyanotic heart disease with multiorgan failure, spinal muscular atrophy Type 1 with hypoxic ischemic encephalopathy (HIE) following cardiorespiratory arrest, HIE secondary to drowning, fulminant meningoencephalitis, inoperable brainstem glioma with respiratory arrest and relapsed primitive neuroectodermal tumour with sepsis. Six patients were transported home for withdrawal of life support and two to hospices for palliation. There were no intra-transfer adverse events. Conclusions: The availability of a dedicated critical care transport service allows for palliative transfers to be carried out safely. We propose that facilitating transport to allow withdrawal of life support at home is an acceptable and valuable option to families as part of holistic end-of-life care.