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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 Teams United Kingdom 2014Cooling methodology used by each transport team in the UK
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FIG6: Transport Teams United Kingdom 2014Cooling methodology used by each transport team in the UK

Mentions: When the survey was repeated in December 2013 and 2014 (Table 1), the number of transport services delivering servo-control during neonatal transport had continued to increase. All of the services contemplating moving to servo-control had completed the move. In 2014, 14 out of 21 transport services were using servo-control through the use of a Criticool or Tecotherm machine (Figure 6). Neonates needing a transfer for cooling in an additional region were cross covered by a service providing servo-controlled cooling, bringing the total to 15. Four of these transport services modified their existing trolleys to allow incorporation of the Tecotherm device. The remaining were securing the cooling machine (Tecotherm/Criticool) in a fixation trolley separate to the transport trolley. In the 14 services using servo-controlled cooling, all but one of the neonatal transport services currently have a dedicated ambulance. After performing Fisher Exact Testing, teams performing servo-control cooling were more likely to have a dedicated ambulance than teams using a local ambulance service (92% vs 44%, The two-tailed P value equals 0.04).


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

Sharma A - Cureus (2015)

Transport Teams United Kingdom 2014Cooling methodology used by each transport team in the UK
© Copyright Policy - open-access
Related In: Results  -  Collection

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

FIG6: Transport Teams United Kingdom 2014Cooling methodology used by each transport team in the UK
Mentions: When the survey was repeated in December 2013 and 2014 (Table 1), the number of transport services delivering servo-control during neonatal transport had continued to increase. All of the services contemplating moving to servo-control had completed the move. In 2014, 14 out of 21 transport services were using servo-control through the use of a Criticool or Tecotherm machine (Figure 6). Neonates needing a transfer for cooling in an additional region were cross covered by a service providing servo-controlled cooling, bringing the total to 15. Four of these transport services modified their existing trolleys to allow incorporation of the Tecotherm device. The remaining were securing the cooling machine (Tecotherm/Criticool) in a fixation trolley separate to the transport trolley. In the 14 services using servo-controlled cooling, all but one of the neonatal transport services currently have a dedicated ambulance. After performing Fisher Exact Testing, teams performing servo-control cooling were more likely to have a dedicated ambulance than teams using a local ambulance service (92% vs 44%, The two-tailed P value equals 0.04).

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.