When do you declare death when a baby dies during transfer and do you continue ventilator support?

Difficult scenario, I must admit have no personal experience.

But if I'd get the phone call from the ambulance and asked for advice it would something like this - "Keep the warmer but stop ventilation. Keep everything else as is and we arrange with extubation, catheters out, cleaning/dressing etc when you and the parents has arrived safely here"

Warmer and stopped ventilation - I would feel disrespectful towards the infant if he/she got cold and also to keep on ventilating.

I would consider the actual death time as is (during transport) but I would feel really bad if the parents would not present when the body of the infant is taken care off after death. 

I suppose the answer to this partly depends on whether you expected this event or not.

We sometimes move very sick patients where we are concerned that they may not survive the journey (but the only hope of survival is to make the move ) .. I’ll give TGA with intact septum needing septostomy as an example , but there are a few more. 

You can then plan in advance what to do if the baby dies (resuscitate or not , continue to receiving unit or return to base hospital)

 

however when it’s unexpected it’s more tricky , and what you do depends on your seniority , job title and location at time of collapse 

 

if you are a very senior clinician you can probably decide all that yourself, but if you are not you should  phone back to base for advise .. legitimate choices are to either stop resus after full resus attempts In the back of the stationary ambulance  (as it is futile) or continue resus and either return to origin , continue to planned destination or head to the nearest medical facility for support. (Some of this may depend on where the parents are) 

 

there is a difference between the time you stop Resus , the time you recognise death and in the UK the time you certify death. 

 

so in summary . A range of options are available 

at one end stopping all resus efforts and recognising death in the back of the ambulance hence stopping all ICU treatments, through to full resus efforts that continue until you reach a team that can make that decision even if that takes longer than you feel comfortable with 

 

what I wouldn’t do .. is to recognise futility ie asystole after 20 mins resus, recognise death but still carry on ICU (ie ventilation, inotropes etc)  

 

there is some legal stuff about who can “certify death” in the UK (for example ANNPs can’t ) 

 

ps - where do you work , your local neonatal transport team might have a guideline on it 

 

james 

If parents are not well prepared for the dangerous situation, I prefer to follow transport and get help from the arrival unit team 

if I already prepared the parents and they know how dangerous is the situation, I stop all, get back to my original departure cause usually it is our hospital and explain everything.