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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.


Transport Trolley with Secure Cooling MachineThis trolley can be secured in any front-line ambulance with a Falcon 6 base
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FIG4: Transport Trolley with Secure Cooling MachineThis trolley can be secured in any front-line ambulance with a Falcon 6 base

Mentions: For teams wanting to employ servo-controlled cooling, innovation and adopting new technology is key. Existing transport trolleys can be modified to secure the cooling machine in a secure box within the trolley. This enables use of frontline ambulances. The Tecotherm machine is 7.2 kg compared to the Criticool which is 35 kg. The Criticool or Tecotherm can be secured on a ramp separate to the trolley in the ambulance [6]. For teams who are currently modifying their trolleys, in order to minimise the complication of increased weight and/or to accommodate the servo-control cooling machine, other equipment might need to be sacrificed. Sourcing battery power for the cooling machine is possible in the ambulance but not during transfer from the unit to the ambulance. The availability of dedicated neonatal transport ambulances, which could allow servo-controlled machines to be adequately secured or provide a source of battery power (Figure 4), helps facilitate servo-control. Johnston, et al. in the United Kingdom developed a system [6]. A similar system is in use by the West Midlands Neonatal Transport Service (Figure 1).  Crash testing of systems takes place through a concept called Finite Element Analysis. This technique is used to analyse the stresses, displacement, and ultimately, the factor of safety of the trolley when subjected to ten times the load. This is through computerised testing and simulates the equipment essentially being virtually crash-tested. This survey did not analyse whether all the teams using servo-controlled cooling had been through such a process. For teams wanting to transition to servo-control, this is an important consideration with implications for cost, safety, and insurance.


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

Sharma A - Cureus (2015)

Transport Trolley with Secure Cooling MachineThis trolley can be secured in any front-line ambulance with a Falcon 6 base
© Copyright Policy - open-access
Related In: Results  -  Collection

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

FIG4: Transport Trolley with Secure Cooling MachineThis trolley can be secured in any front-line ambulance with a Falcon 6 base
Mentions: For teams wanting to employ servo-controlled cooling, innovation and adopting new technology is key. Existing transport trolleys can be modified to secure the cooling machine in a secure box within the trolley. This enables use of frontline ambulances. The Tecotherm machine is 7.2 kg compared to the Criticool which is 35 kg. The Criticool or Tecotherm can be secured on a ramp separate to the trolley in the ambulance [6]. For teams who are currently modifying their trolleys, in order to minimise the complication of increased weight and/or to accommodate the servo-control cooling machine, other equipment might need to be sacrificed. Sourcing battery power for the cooling machine is possible in the ambulance but not during transfer from the unit to the ambulance. The availability of dedicated neonatal transport ambulances, which could allow servo-controlled machines to be adequately secured or provide a source of battery power (Figure 4), helps facilitate servo-control. Johnston, et al. in the United Kingdom developed a system [6]. A similar system is in use by the West Midlands Neonatal Transport Service (Figure 1).  Crash testing of systems takes place through a concept called Finite Element Analysis. This technique is used to analyse the stresses, displacement, and ultimately, the factor of safety of the trolley when subjected to ten times the load. This is through computerised testing and simulates the equipment essentially being virtually crash-tested. This survey did not analyse whether all the teams using servo-controlled cooling had been through such a process. For teams wanting to transition to servo-control, this is an important consideration with implications for cost, safety, and insurance.

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.