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Physicians Update


Physicians Update

Winter 2013

High-Tech Transport System

Enhances Care for Critically Sick Infants

UCLA Pediatric Transport Team designed first isolette for neonatal patientsA new transport system for newborns codesigned by UCLA's Pediatric Transport Team is the first isolette in the country that allows critically ill infants to be safely moved from an ambulance to a helicopter or fixed-wing aircraft without modification. Combined with the UCLA team's recent partnership with REACH Air Medical Services, the innovative device extends the reach of UCLA's expertise in life-saving neonatal intensive care.

Measuring six feet long and two feet high, the isolette includes a heated transparent enclosure that affords the medical team access to the infant on two sides, as well as a base containing emergency medical equipment, such as a ventilator and a monitor. "This system allows us to provide full monitoring and medical care for newborns who urgently need surgery or other care where time is of the essence," says Robert Kelly, MD, the Pediatric Transport Team's associate medical director. "It's essentially a mobile NICU."

Each month, approximately 12 to 15 newborns are referred to Mattel Children's Hospital UCLA from regional hospitals in areas such as Bakersfield, Santa Barbara and the Antelope Valley. The team can easily reach adjacent states such as Nevada and Arizona by fixed-wing aircraft. In addition, several critical-care ambulance transports are made each month on an intra-facility basis from UCLA Medical Center, Santa Monica to Ronald Reagan UCLA Medical Center.

Robert Kelly, MD with the infant isoletteFor emergency inter-facility transports, a helicopter lands on the helipad of the Westwood hospital to pick up the Pediatric Transport Team and the isolette. Each air-transport team includes a paramedic or nurse from REACH as well as a UCLA critical-care pediatric nurse, pediatric respiratory therapist and, depending on the patient's acuity, a pediatric ICU fellow or attending physician. Once the UCLA team reaches the referring hospital, it works with that hospital's team to transfer the patient to the isolette, which can then be brought to the aircraft that brings him or her to UCLA.

Since the new isolette can go between an ambulance and a helicopter or airplane without any modification, this saves valuable time and minimizes any jostling and other stimulation to the baby. Of particular importance for the smallest neonates, who tend to be sensitive to cold, the isolette is fully temperature controlled. "Especially for premature babies, you want to minimize the movement and adjustment as much as possible, and the isolette easily slides in and out of all three transportation vehicles," explains Dr. Kelly. "The enclosure allows us to keep them warm and minimizes external noise and exposure, which can predispose them to cardiac instability or neurological injuries."

This "mobile NICU" includes the same cardiac and respiratory monitoring that a typical neonatal ICU bed would have at a tertiary care center. Given that most critically ill neonates have respiratory difficulties, the availability of not only a conventional ventilator but also a high-frequency flow interrupter and nitric oxide for infants with low oxygen saturation is valuable, Dr. Kelly says.

UCLA Pediatric Transport TeamDr. Kelly notes that the gravely ill newborns seen at UCLA tend to be premature babies, some with a gestational age of 23 weeks. Among the special expertise UCLA brings is the ability to transport newborns back to UCLA for therapeutic hypothermia treatment, a new method of cooling neonates after traumatic births in which they have experienced asphyxia, which must be initiated within six hours. Other common referrals are for cardiac surgery in the case of infants with congenital heart defects; heart failure; complex neurology and neurosurgery interventions; and cases of respiratory failure, including the need for nitric oxide. The UCLA team provides complete cardiac and respiratory support during the transport process. The critical-care nurse and respiratory therapist on the team are highly experienced with special training in pediatric transport.

In an effort to reduce response times, UCLA's Pediatric Transport Team forged a partnership with REACH to transport sick babies to UCLA. Compelled to modify the isolette to fit into the company's aircraft, the UCLA Pediatric Transport Team worked with REACH for more than a year on a novel design that would both meet the special needs of critically ill neonates and fit within the constraints of modern medical helicopters and aircraft. Any baby under 5 kilograms should be in an isolette with ICU-type monitoring during transport, Dr. Kelly says.

"This allows us to extend UCLA's expertise to centers that in the past we might not have been able to reach in poor weather conditions, and it significantly increases the speed with which we are able to get to these facilities," Dr. Kelly concludes. "That has the potential to save lives."

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