title: Incidence of re-arrest and critical events during prolonged transport of post-cardiac arrest patients.
abstract: OBJECTIVE
  To determine the feasibility of transporting post-cardiac arrest patients to tertiary-care facilities, the rate of re-arrest, and the rate of critical events during critical care transport team (CCTT) care.
  
  
  METHODS
  Retrospective chart review of cardiac arrest patients transported via CCTT between 1/1/2001 and 5/31/2009. Demographic information, re-arrest, and critical events during transport were abstracted. We defined critical events as hypotension (systolic blood pressure<90mmHg), hypoxia (oxygen saturation<90%), or both hypotension and hypoxia at any time during CCTT care. Comparisons were performed using Chi-squared test and a Cox proportional hazards model was employed to determine predictors of events.
  
  
  RESULTS
  Of the 248 patients studied, the majority was male (61%), presented in ventricular fibrillation or ventricular tachycardia (VF/VT, 50%), and comatose (80%). Re-arrest was uncommon (N=15; 6%). Critical events affected 58 patients (23%) during transport. Median transport time was 63min (IQR 51, 81) in both those who experienced a critical event and those who did not. Vasopressor use was associated with any decompensation during CCTT (Hazard Ratio 1.81; 95%CI 1.29, 2.54). Three patients (20%) suffering re-arrest survived to hospital discharge. Survival (Chi square 11.77; p<0.01) and good neurologic outcome (Chi square 5.93; p=0.01) were higher in patients who did not suffer any event during transport.
  
  
  CONCLUSIONS
  Transport of resuscitated cardiac arrest patients to a tertiary-care facility via CCTT is feasible, and the duration of transport is not associated with re-arrest during transport. Repeat cardiac arrest occurs infrequently, while critical events are more common. Outcomes are worse in those experiencing an event.
authors.affiliation: University of Pittsburgh, Affiliated Residency in Emergency Medicine, PA 15261, United States.
authors.forename: A
authors.initials: A
authors.lastname: Hartke
authors.forename: B E
authors.initials: BE
authors.lastname: Mumma
authors.forename: J C
authors.initials: JC
authors.lastname: Rittenberger
authors.forename: C W
authors.initials: CW
authors.lastname: Callaway
authors.forename: F X
authors.initials: FX
authors.lastname: Guyette
mesh_terms: D016887:Cardiopulmonary Resuscitation / Q000379:methods*; D003422:Critical Care / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006323:Heart Arrest / Q000453:epidemiology* / Q000628:therapy; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012189:Retrospective Studies; D013997:Time Factors; D014187:Transportation of Patients / Q000379:methods*; D014481:United States / Q000453:epidemiology