O3306: Interfacility transport response time for pediatric out-of-hospital cardiac arrest: can we do better?

Background: Children with out-of-hospital cardiac arrest (OHCA) are often transported by EMS to the nearest hospital, and subsequently transferred to a pediatric center only if a return of spontaneous circulation (ROSC) occurs. Our quaternary center’s pediatric transport team (PTT) rapidly dispatches to community hospitals for children in cardiac arrest to deliver state-of-the-art resuscitative care as soon as possible and to potentially facilitate access to life-saving extracorporeal support. However, current rapid dispatch procedures necessitate first receiving the transfer request from the sending facility. Thus, both prehospital and stabilization time at the referring institution are possible targets for QI efforts. More than 25% of pediatric referrals come from one affiliated community hospital 24 miles away. To increase pediatric support to this nearby community, we have partnered with that community’s EMS agency and referring pediatric ED (PED) leadership to develop and pilot a new protocol that entails early PTT notification about any prehospital transport of a child with OHCA to that referring PED (Figure).

Methods: Our goals are to: 1) perform a 5-year retrospective chart review of children ≤18 years old with OHCA transported by local EMS to our affiliated hospital’s PED to identify those whose transfer to our center was requested between 01/01/2019 and 12/31/2023, ascertain the pre-intervention PTT response time, and report outcomes for these patients; and 2) assess the feasibility of implementing this pilot program by debriefing subsequent calls to monitor quality metrics, track outcomes, identify/address implementation barriers and unforeseen effects, and make needed changes.

Results: Pre-intervention, 27 children with OHCA were transported to our affiliated hospital (Table). Their median (IQR) CPR duration was 59 (38.5-68) minutes, and 4/27 (14.8%) had prehospital ROSC. Interfacility transfer was requested for 11/27 (40.7%) patients, resulting in one consult and ten PTT activations, which led to four interhospital transports (all patients survived to discharge). Median (IQR) times from patient arrival at the referring hospital to PTT dispatch was 16.5 (7.5-34.5) minutes, and to PTT arrival at the bedside was 55 (42-70) minutes. The new protocol was successfully piloted in January 2024 with an index case that involved a 17-year-old male with ventricular fibrillation OHCA and prehospital ROSC for whom PTT was dispatched 11 minutes before he arrived at the referring hospital, hence decreased times from patient to PTT arrival at the referring hospital (24 vs. 55 minutes) and from EMS dispatch on scene to PTT arrival (59 vs. 89 minutes) compared to pre-intervention.

Conclusion: Analysis of this 5-year OHCA cohort revealed delays in interfacility transport team activation. Early data suggests that a new transfer protocol could potentially save significant time. We will continue to refine this process, with hopes of broader expansion throughout the region.