G410 Small hearts, big risk? service evaluation of cardiac transfers undertaken by a neonatal transport team

Abstract

Aims For capacity and geographical reasons our neonatal transport team undertakes a significant number of emergency cardiac transfers when requested by the supra-regional paediatric retrieval service. We reviewed our practice with a focus on safety, identifying training needs for the team, specific to this high-risk patient group. Methods Retrospective review of all cardiac transfers undertaken between September 2014 and September 2016. Demographic and clinical data, including underlying diagnosis, referring and receiving centres, level of clinical support required, response times and the infant’s clinical status on arrival to the receiving centre were reviewed. Possible areas of risk were identified for inclusion in education and training programmes. Results 50 cardiac transfers were completed over the 2 year period, 25 planned transfers (VSD, PDA, TAPVD/ASD, TOF/critical PS) and 25 unplanned emergencies (TGA, CoAo, AS, HLH/ DORV, PS). Most infants (78%) were term at transfer, median age 8 (0–62) days. The median weight at transfer was 2.5 (0.58–4.7) Kg. Only 26% had an antenatal cardiac diagnosis. 42% of infants required respiratory support, though only 16% were ventilated. 15 (30%) were transferred with a Prostaglandin infusion due to a suspected duct-dependent lesion, 4% required inotropic support. Infants were referred equally from all levels of neonatal care (around 33% each) largely to two main recipient cardiac centres. The median time to dispatch in the unplanned emergencies was above the national standard for neonatal transport teams (1.2 hours), but the median response time (from call to team’s arrival at referring unit) was well within the national standard (2.5 hours). There were no significant adverse events during transfer and all infants arrived in good condition, including 4 infants with TGA, 2 of whom required urgent septostomy. Conclusions Emergency transfers of infants with undiagnosed cardiac lesions can be high risk. Antenatal diagnosis and pulse oximetry screening to facilitate early detection may reduce this. 25 infants requiring unplanned emergency transfer were safely transported to cardiac centres by our neonatal transfer service (2.3% of total unplanned emergencies). Collaboration between transport teams resulted in good patient outcome. Though no adverse events occurred, we identified several training needs to be addressed in our education programme.