Inter-hospital transfer of critically-ill patients for urgent cardiac surgery after placement of an intra-aortic balloon pump.

METHODS

To assess the safety and feasibility of transfer of patients requiring urgent cardiac surgery, from a hospital without onsite cardiac surgical facilities, after insertion of an intra-aortic balloon pump (IABP) to maintain clinical and hemodynamic stability, a retrospective review of all cardiac charactheterizations was performed. Sixty-two patients required IABPs, among whom 24 were transported to a surgical center from the outskirts of Lisbon to the city center in an ambulance accompanied by a physician, a nurse and paramedical personnel.

RESULTS

Patients who required hemodynamic support with IABPs usually had unstable angina with critical coronary lesions requiring immediate surgical intervention, hypotensive patients with mechanical complications after an AMI, and patients with AMI who did not receive thrombolytic therapy, and with coronary lesions not amenable to percutaneous coronary intervention. All patients reached the surgical center alive, and no patient had either hemodynamic or electrical instability during transport.

CONCLUSIONS

Surface transport of patients requiring emergency cardiac surgery after insertion of IABPs is safe, feasible and may provide circulatory and clinical stability in a subset of critically-ill patients.