Inter-hospital transport of critically ill patients to manage the intensive care unit surge during the COVID-19 pandemic in France

Benoit Painvin; Hélène Messet; Maeva Rodriguez; Thomas Lebouvier; Delphine Chatellier; Louis Soulat; Stephane Ehrmann; Arnaud W Thille; Arnaud Gacouin; Jean-Marc Tadie

doi:10.1186/s13613-021-00841-5

Inter-hospital transport of critically ill patients to manage the intensive care unit surge during the COVID-19 pandemic in France

Ann Intensive Care. 2021 Mar 31;11(1):54. doi: 10.1186/s13613-021-00841-5.

Authors

Benoit Painvin¹, Hélène Messet², Maeva Rodriguez³, Thomas Lebouvier⁴, Delphine Chatellier³, Louis Soulat⁵, Stephane Ehrmann^{6

7}, Arnaud W Thille³, Arnaud Gacouin^{8

9}, Jean-Marc Tadie^{10

11}

Affiliations

¹ Service de Réanimation Médicale et des Maladies Infectieuses, Centre Hospitalier Universitaire de Rennes, Hôpital Pontchaillou, 2 rue Henri le Guilloux, 35033, Rennes Cedex 9, France. benoit.painvin@chu-rennes.fr.
² Service de Médecine Intensive et Réanimation, Centre Hospitalier Régional Universitaire de Tours, Hôpital Bretonneau, 2, boulevard Tonnellé, 27044, Tours cedex 9, France.
³ Service de Médecine Intensive et Réanimation, Centre Hospitalier Universitaire de Poitiers, 2 rue de la Milétrie, CS 90577, 86000, Poitiers, France.
⁴ Service de Réanimation Chirurgicale, Centre Hospitalier Universitaire de Rennes, Hôpital Pontchaillou, 2 rue Henri le Guilloux, 35033, Rennes Cedex 9, France.
⁵ Service Samu-Smur-Urgences médico-chirurgicales adultes, Centre Hospitalier Universitaire de Rennes, Hôpital Pontchaillou, 2 rue Henri le Guilloux, 35033, Rennes Cedex 9, France.
⁶ Service de Médecine Intensive et Réanimation, CIC INSERM 1415, CRICS-Triggersep Research Network, Centre Hospitalier Régional Universitaire de Tours, Hôpital Bretonneau, 2, boulevard Tonnellé, 27044, Tours cedex 9, France.
⁷ Centre d'étude des Pathologies Respiratoires, INSERM U1100, Université de Tours, Tours, France.
⁸ Service de Réanimation Médicale et des Maladies Infectieuses, Centre Hospitalier Universitaire de Rennes, Hôpital Pontchaillou, 2 rue Henri le Guilloux, 35033, Rennes Cedex 9, France.
⁹ Faculté de Médecine, Université de Rennes 1, Unité INSERM CIC 1414, IFR 140, Rennes, France.
¹⁰ Service de Réanimation Médicale et des Maladies Infectieuses, Centre Hospitalier Universitaire de Rennes, Hôpital Pontchaillou, 2 rue Henri le Guilloux, 35033, Rennes Cedex 9, France. jean-marc.tadie@chu-rennes.fr.
¹¹ Faculté de Médecine, Université de Rennes 1, Unité INSERM CIC 1414, IFR 140, Rennes, France. jean-marc.tadie@chu-rennes.fr.

Abstract

Background: The COVID-19 pandemic led authorities to evacuate via various travel modalities critically ill ventilated patients into less crowded units. However, it is not known if interhospital transport impacts COVID-19 patient's mortality in intensive care units (ICUs). A cohort from three French University Hospitals was analysed in ICUs between 15th of March and the 15th of April 2020. Patients admitted to ICU with positive COVID-19 test and mechanically ventilated were recruited.

Results: Among the 133 patients included in the study, 95 (71%) were male patients and median age was 63 years old (interquartile range: 54-71). Overall ICU mortality was 11%. Mode of transport included train (48 patients), ambulance (6 patients), and plane plus helicopter (14 patients). During their ICU stay, 7 (10%) transferred patients and 8 (12%) non-transferred patients died (p = 0.71). Median SAPS II score at admission was 33 (interquartile range: 25-46) for the transferred group and 35 (27-42) for non-transferred patients (p = 0.53). SOFA score at admission was 4 (3-6) for the transferred group versus 3 (2-5) for the non-transferred group (p = 0.25). In the transferred group, median PaO₂/FiO₂ ratio (P/F) value in the 24 h before departure was 197 mmHg (160-250) and remained 166 mmHg (125-222) in the first 24 h post arrival (p = 0.13). During the evacuation 46 (68%) and 21 (31%) of the patients, respectively, benefited from neuromuscular blocking agents and from vasopressors. Transferred and non-transferred patients had similar rate of nosocomial infections, 37/68 (54%) versus 34/65 (52%), respectively (p = 0.80). Median length of mechanical ventilation was significantly increased in the transferred group compared to the non-transferred group, 18 days (11-24) and 14 days (8-20), respectively (p = 0.007). Finally, ICU and hospital length of stay did not differ between groups.

Conclusions: In France, inter-hospital evacuation of COVID-19 ventilated ICU patients did not appear to increase mortality and therefore could be proposed to manage ICU surges in the future.

Keywords: ARDS; COVID-19; Hospital transport; Intensive care unit; Mechanical ventilation; Mortality.