Critical Care Retrieval in the Middle East: Descriptive Analysis of a Multidisciplinary Adult Critical Care Transfer and Retrieval Service in Qatar
Abstract Introduction The regionalisation of critical care resources has led to an increase in the need to transfer patients between facilities. The advent and implementation of critical care transfer and retrieval services have been the bridge to this divide, lying at the confluence of prehospital emergency care, in-hospital emergency medicine, and intensive care. Within the State of Qatar, the concept of critical care transfer and retrieval is a relatively new. Consequently, we conducted a retrospective cross-sectional study of all transfer and retrieval activity of a dedicated multidisciplinary transfer and retrieval service to better understand the use of these services in the region. Methods Extracted patient care record data were analysed and described using univariate and multivariate descriptive statistics. A log-binomial regression model with robust variance estimator was used to calculate crude and adjusted prevalence ratios for intubation status and arteriovenous access; and intubation status and medication combination, adjusting for age and gender for each model. Results Amongst the completed cases, the majority were male (60.39%), and within the 40-59 (27.7%) age group. Amongst the cases transferred, those with a primary respiratory pathology were the most common (19.59%), followed by cardiovascular patients (18.5%). Half of all patients had a self-maintained airway (51.6%), followed by a third who had an endotracheal tube in situ (36.74%). Midazolam was the most common hypnotic administered (51.27%), as was Fentanyl (88.02%) amongst the analgesic medications, and Noradrenaline amongst the inotropes (72.77%). Intubated patients had the highest proportion of severe and critical patients; patients transported with a Doctor; patients with multiple routes of arterial and/or venous access; and patients receiving any hypnotic, analgesic or inotrope, or a combination thereof. Conclusion The transfer and retrieval of critical care patients across Qatar is a relatively common occurrence. Variations in patient type and severity and the expectations of the transfer team, are significant. Variation in airway type and ventilation modalities, types and combinations of hypnotic, analgesic and inotropes used, and the multitude of arteriovenous access points observed in this study directly contributed towards the complexity of moving these patients from one facility to another.