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46 Prolonged intensive care stay after cardiac surgery: is repatriation to a general ICU safe?
  1. A Gregg,
  2. F Groogan,
  3. A Graham
  1. Royal Victoria Hospital, Belfast, UK

Abstract

Introduction Many patients having cardiac surgery will live many miles from the specialist centre. Therefore, prolonged intensive care stay after cardiac surgery will add the burden of long journeys for the family to visit. With the availability of an ICU bed being the major limiting effect on delivering cardiac surgery, repatriation to local services, if safe, has many benefits. We have audited the outcomes of repatriation after cardiac surgery in Northern Ireland.

Methods Between April 2012 and March 2014, 28 patients were repatriated from the regional cardiac surgery intensive care (CSICU) and high dependency unit (CSHDU) (16 from CSICU and 12 from CSHDU). The discharge from intensive care rate and overall survival rate was compared to a matched group of patients with a similar length of stay who remained in the regional unit.

Results Patients were repatriated to general ICUs in 13 cases and of the remainder, the most common destination was coronary care units (n = 6) followed by general HDUs (n = 3). Patients were repatriated from CSHDU on median post-operative day 10 (range 5 to 22) and from CSICU on median 20 (range 5 to 65). The in-hospital mortality rate of the patients repatriated from CSICU was 15.4% compared to 17.2% of those who remained in the regional unit. Of the 13 transferred to ICUs, 1 died after a further 56 days in ICU and another died after discharge from ICU 18 days post-transfer after a further 28 days in rehabilitation. The total length of stay in ICU of the 13 transferred was 385.37 days, giving an average of 29.6 days per patient.

Conclusion Repatriation to local services after cardiac surgery was not associated with a decrease in survival and has benefits for the patient and their family. It also allows valuable resources to be directed to those awaiting specialist cardiac surgical interventions. 1 died in ICU and 1 in the local hospital after discharge from ICU with 26 surviving to hospital discharge (93%). This study revealed that there was no difference to the patients outcome, and indeed, the repatriated group had a slightly better outcome.

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