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Unimaginable Scenario

Arrival of the crew: 0308 to 0337 am. The flight crew re-intubates the patient for a dislodged tube, continued CPR, then placed an LMA for another dislodged tube, placed a UVC, administered epi, obtains ROSC, checks on Mother of Child (MOC), and performs fundal check. Makes decision to move to ambulance for transport. Directs EMS crew to care for MOC. All of these procedures are performed in minimal lighting.
Ongoing: 0340 to 0432. Crew and patients are now located in the ambulance. UVC dislodged and had to reinsert a second catheter. Continued positive pressure ventilation and made a medical decision to request additional assistance and a Neonate team to rendezvous at nearest hospital. Crew continues NRP protocols to delivery at receiving hospital while monitoring the EMS crew and directing care of the MOC.
The Impact
The neonate team met our crew in the ED and care was transferred to them for transport to a Level 1 NCIU, where the baby was delivered alive but care was withdrawn by the family decision after determining an anoxic brain injury incompatible with life. This baby had an undiagnosed diaphragmatic hernia. The MOC’s only prenatal care was delivered by a midwife.
The Background on the Scenario
This baby took one breath after birth and then ceased to breath, at which point the MOC started CPR until EMS arrived. Newborns with diaphragmatic hernia occur in about 1 in 2,400 births and are typically treated with hospitalization prior to birth. Even when all resources are available and teams rehearse, the survival rate for these patients is 50 percent if the baby is initially placed on ECMO.