Abstract
BACKGROUND: Pediatric patients requiring life-sustaining interventions (LSIs) constitute a critically ill population characterized by a high risk of rapid clinical deterioration, necessitating precise and timely medical interventions. Emergency Medical Services (EMS) transport strategies vary, with the Franco-German (FG) (physician-led) "stay and play" model emphasizing advanced prehospital care and the Anglo-American (AA) (paramedic-led) "scoop and run" approach prioritizing rapid transport. This study evaluates the influence of transport modality on prehospital LSIs, clinical outcomes, and the personnel performing these interventions. METHODS: This prospective, multicenter, observational study included 16 emergency departments (EDs) across four European countries over a four-week period. Children (≤ 18 years) who received LSIs in the ED were included. Patients were stratified by transport modality: FG-EMS (physician-led) and AA-EMS (paramedic-led). The study analyzed the rate and type of LSIs performed, the personnel administering interventions, prehospital transport times, and clinical outcomes including pediatric intensive care unit (PICU) admission and mortality. RESULTS: A total of 133,634 patients visited during the study period, of whom 12,087 (9.0%) were transported via EMS. Among these, 4.7% (n = 631) received LSIs in the ED and were included in the study. The median daily ED visits were 136 (IQR:110-251), with 8 ambulance arrivals (IQR:5-12). Most LSIs were performed on patients transported by parents (56.7%), while 43.3% were EMS transports. Among EMS transports, 18.6% utilized the physician-led (FG) model, and 81.4% used the paramedic-led (AA) model. LSIs during transport occurred in 19.4% of EMS patients, significantly more in FG than AA (43.1 vs. 13.9%) (p < 0.001). No invasive procedures were performed in AA transports, which had shorter transport times compared to FG (median 20 vs. 31 min) (p = 0.001). Most patients requiring LSIs presented with medical emergencies (75.1%). FG transports had higher PICU admission (41.2% vs. 21.6%) and mortality rates (9.8% vs. 1.8%) (p = 0.004 and p = 0.012, respectively). CONCLUSION: The transport modality significantly influenced the pre-hospital management and clinical outcomes of children requiring LSIs. FG transports were associated with more comprehensive pre-hospital interventions but longer transport times and higher PICU admission and mortality rates. These findings highlight the need for optimizing pre-hospital care and transport protocols to improve outcomes in critically ill children.