‍Background:

‍Weekend call from line manager giving information that CCU requested assistance to transfer a patient with an intra aortic balloon pump (IABP) in situ to another hospital. CCU were unable to locate a member of the cardiology team that could transfer the patient, therefore the on-call perfusionist was needed to transfer the patient.

Information Provided:
 
Arrived in CCU, patient awake with Arrow IABP in situ, ECG trigger via direct lead monitoring, 1 in 2 augmentation, set by cardiology team due to tachycardia.
IABP checked over, no apparent spare battery or obvious visual of battery status when disconnected from mains electricity, only a written message on screen stating, ‘on  battery’. The journey time from one hospital to the other was around 50 minutes plus time to and from ITUs to the vehicle, the battery life is supposedly up to 90 mins.
 
Checked with ambulance  crew, mains electricity on board. After consideration, I thought this would  be okay. Helium tank levels adequate.
Transducer flush system all in working order, adequate Hep/saline in flush bag which was pressurised. Insertion site checked, no oozing but IAB catheter was not sutured in place. It was securely dressed but a further X2 Tegaderm dressing applied to be sure. Patient was organised and transferred onto ambulance transport trolley, this seemed very short with the patients feet hanging off the end (socks and blankets applied to patients feet).

When we arrived at the ambulance it became apparent that the hydraulic ramp which transfers the patient transport trolley into the vehicle was too short to hold both the  patient trolley and the IABP.

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Action taken to overcome  this: as the hydraulic ramp was raised three members of the team manually lifted the IABP at the same time, and pushed the IABP onto the ambulance! The  alternatives to this would involve either returning to ITU to procure another, more suitable ambulance. Or, to temporarily disconnect the IABP from  the patient. Both these options could have detrimental effects on patient’s  physical and mental well-being and safety by causing haemodynamic instability  and increased anxiety levels.
 
Once on the ambulance the  IABP was plugged into the mains supply, however, the machine remained in the battery power supply mode. Ambulance crew informed, and the engine was  started to see if this made a difference. Unfortunately not! Crew considered that as we drove the power source could charge up and sufficiently power the mains for the IABP.

Decision was made to continue journey as

1. Didn't want to waste valuable time and delay the patient access to the care required.

2. Patient was cardiovascularly stable

3. Didn't want to risk instability by returning to ITU and increase patients anxiety levels

4. Patient needed to be transferred to Harefield hospital and couldn't be sure how long it would take to find an alternative

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The journey started and as it progressed it became apparent that the mains power supply was not going to start up. There was no display on the Arrow AutoCat2 IABP battery status, only that it was on battery.

The ambulance crew were advised of the situation, they suggested a mid-point to transfer to another ambulance as this would take time to arrange and likely include a diversion I felt the best plan was to carry on.

After approximately 20minutes of travel time I called the perfusionist at the hospital we were going to who advised that cardiac physiologists are responsible for IABP at the institution so she passed on my contact details to the appropriate person. The cardiac physiologist made contact and advised he would be waiting with a IABP fully charged and ready to transfer onto.

The IABP did give a "less than 20 minutes battery" and "less than 10minutes battery warning". This was running almost parallel to the ambulance satellite navigation system ETA. As we turned onto the hospital I called the cardiac physiologist to inform him of our arrival and to let him help direct the ambulance crew.

As they were speaking the IABP battery ran out and the unit switched off. The patients haemodynamics remained unchanged and the IABP was disconnected from the patient to promote easy disembarkment from the ambulance, followed by a swift and calm transfer to ITU without further incident. The patient was safely attached to a new IABP. (The battery failed at 50-60mins. The battery is routinely replaced at the annual service, there was no indication when the service has been carried out).

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Points of concern

Contactability of cardiology team

Clarity of responsibility for transferring patients' on IABP

No battery status on IABP

IABP not secured in position

Patient transport trolley not long enough

Hydraulic ramp for patient not long enough for transfer trolley and IABP

Power supply failure on ambulance

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