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Provision of Therapeutic Hypothermia in Neonatal Transport: A Longitudinal Study and Review of Literature.

Sharma A - Cureus (2015)

Bottom Line: Teams have done this through modification of transport trolleys and dedicated ambulances.The question remains whether it should be endorsed as a standard of care.Some teams continue to passively cool neonates with hypoxia-ischaemia during transport.

View Article: PubMed Central - HTML - PubMed

Affiliation: Neonatal Medicine and Surgery, University Hospital Southampton.

ABSTRACT

Background: Worldwide, a significant proportion of infants needing therapeutic hypothermia for hypoxia-ischaemia are transported to a higher-level facility for neonatal intensive care. They pose technical challenges to transport teams in cooling them. Concerns exist about the efficacy of passive cooling in neonatal transport to achieve a neurotherapeutic temprature. Servo-controlled cooling in the standard of care on the neonatal unit. The key question is whether the same standard of care in the neonatal unit can be safely used for therapeutic hypothermia during transport of neonates with suspected hypoxia-ischaemia.

Methods: A prospective cross-sectional survey of United Kingdom (UK) neonatal transport services (n=21) was performed annually from 2011-2014 with a 100% response. The survey ascertained information about service provision and the method of cooling used during transport.

Results: In 2011, all UK neonatal transport services provided therapeutic hypothermia during transport. Servo-control cooling machines were used by only 6 of the 21 teams (30%) while passive cooling was used by 15 of the 21 (70%) teams. In 2012 9 of the 21 teams (43%) were using servo-control. By 2014 the number of teams using servo-control cooling had more than doubled to 15 of the 21 (62%) services. Teams have done this through modification of transport trolleys and dedicated ambulances.

Conclusion: Servo-controlled cooling in neonatal transport is becoming more common in the UK. The question remains whether it should be endorsed as a standard of care. Some teams continue to passively cool neonates with hypoxia-ischaemia during transport. This article reviews the drivers, current evidence, safety and processes involved in provision of therapeutic hypothermia during neonatal transport to enable teams to decide what would be the right option for them.

No MeSH data available.


Tecotherm Machine in Dedicated AmbulanceTecotherm machine secured separate from transport trolley (Photographs courtesy West Midlands Neonatal Transport Team Birmingham United Kingdom)
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FIG2: Tecotherm Machine in Dedicated AmbulanceTecotherm machine secured separate from transport trolley (Photographs courtesy West Midlands Neonatal Transport Team Birmingham United Kingdom)

Mentions: Passive cooling was used by 15 of the 21 (70%) neonatal transport teams. These teams used a passive cooling transport guideline produced by the TOBY group [13]. Servo-controlled equipment for cooling was used by six out of the 21 (30%) neonatal transport services (Figure 1). Teams using servo-controlled cooling did so either through the modification of a dedicated ambulance to secure the cooling machine to a ramp in the ambulance (Figure 2) or a modification of their existing transport trolley to secure the cooling machine in a specialised area on it (Figures 3-5). All but one of the six (83%) transport services providing cooling with a servo-controlled machine used dedicated ambulances in 2011. All used rectal probes to monitor temperature during cooling. Nineteen of the 21 (94%) neonatal transport teams completed audits of temperature control for this group of patients. Fourteen of the 21 (66%) neonatal transport services had a dedicated ambulance, yet only five of 14 (35%) used servo-control cooling during the actual transport process. Approximately half of all services providing passive cooling were considering the use of servo-controlled machines for the purpose of providing cooling during transport at the time of the initial survey in December 2011. On asking them why they had not, the lack of a dedicated ambulance was thought to be a major factor.


Provision of Therapeutic Hypothermia in Neonatal Transport: A Longitudinal Study and Review of Literature.

Sharma A - Cureus (2015)

Tecotherm Machine in Dedicated AmbulanceTecotherm machine secured separate from transport trolley (Photographs courtesy West Midlands Neonatal Transport Team Birmingham United Kingdom)
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4494512&req=5

FIG2: Tecotherm Machine in Dedicated AmbulanceTecotherm machine secured separate from transport trolley (Photographs courtesy West Midlands Neonatal Transport Team Birmingham United Kingdom)
Mentions: Passive cooling was used by 15 of the 21 (70%) neonatal transport teams. These teams used a passive cooling transport guideline produced by the TOBY group [13]. Servo-controlled equipment for cooling was used by six out of the 21 (30%) neonatal transport services (Figure 1). Teams using servo-controlled cooling did so either through the modification of a dedicated ambulance to secure the cooling machine to a ramp in the ambulance (Figure 2) or a modification of their existing transport trolley to secure the cooling machine in a specialised area on it (Figures 3-5). All but one of the six (83%) transport services providing cooling with a servo-controlled machine used dedicated ambulances in 2011. All used rectal probes to monitor temperature during cooling. Nineteen of the 21 (94%) neonatal transport teams completed audits of temperature control for this group of patients. Fourteen of the 21 (66%) neonatal transport services had a dedicated ambulance, yet only five of 14 (35%) used servo-control cooling during the actual transport process. Approximately half of all services providing passive cooling were considering the use of servo-controlled machines for the purpose of providing cooling during transport at the time of the initial survey in December 2011. On asking them why they had not, the lack of a dedicated ambulance was thought to be a major factor.

Bottom Line: Teams have done this through modification of transport trolleys and dedicated ambulances.The question remains whether it should be endorsed as a standard of care.Some teams continue to passively cool neonates with hypoxia-ischaemia during transport.

View Article: PubMed Central - HTML - PubMed

Affiliation: Neonatal Medicine and Surgery, University Hospital Southampton.

ABSTRACT

Background: Worldwide, a significant proportion of infants needing therapeutic hypothermia for hypoxia-ischaemia are transported to a higher-level facility for neonatal intensive care. They pose technical challenges to transport teams in cooling them. Concerns exist about the efficacy of passive cooling in neonatal transport to achieve a neurotherapeutic temprature. Servo-controlled cooling in the standard of care on the neonatal unit. The key question is whether the same standard of care in the neonatal unit can be safely used for therapeutic hypothermia during transport of neonates with suspected hypoxia-ischaemia.

Methods: A prospective cross-sectional survey of United Kingdom (UK) neonatal transport services (n=21) was performed annually from 2011-2014 with a 100% response. The survey ascertained information about service provision and the method of cooling used during transport.

Results: In 2011, all UK neonatal transport services provided therapeutic hypothermia during transport. Servo-control cooling machines were used by only 6 of the 21 teams (30%) while passive cooling was used by 15 of the 21 (70%) teams. In 2012 9 of the 21 teams (43%) were using servo-control. By 2014 the number of teams using servo-control cooling had more than doubled to 15 of the 21 (62%) services. Teams have done this through modification of transport trolleys and dedicated ambulances.

Conclusion: Servo-controlled cooling in neonatal transport is becoming more common in the UK. The question remains whether it should be endorsed as a standard of care. Some teams continue to passively cool neonates with hypoxia-ischaemia during transport. This article reviews the drivers, current evidence, safety and processes involved in provision of therapeutic hypothermia during neonatal transport to enable teams to decide what would be the right option for them.

No MeSH data available.