The LSTAT™ (Life Support for Trauma and Transport)

 LSTAT™ (Life Support for Trauma and Transport)

Life Support for Trauma and Transport: a mobile ICU for safe in-hospital transport of critically injured patients

Abstract

BACKGROUND:

In-hospital transport of newly injured patients is complicated by inadequate monitoring and adverse events. LSTAT (Life Support for Trauma and Transport, Integrated Medical Systems Inc) is a platform with multiple integrated systems (ventilator, defibrillator, suction, hemodynamic monitors, infusion and invasive monitoring channels, capnography, blood analysis, and electrocardiography) that allow seamless monitoring and effective life-saving interventions during transport. The platform functions as a mobile ICU and has preliminarily been tested with success in combat settings. This is the first evaluation of LSTAT in the civilian transport arena.

 LSTAT™ (Life Support for Trauma and Transport)

STUDY DESIGN:

Major trauma patients requiring trauma team activation, who were transported from the Emergency Department through different hospital departments (usually CT or angiography) to the ICU or operating room were included prospectively (December 2002 through April 2003). Patients were monitored and transported either by conventional means (conventional group) or by LSTAT (LSTAT group). Primary outcomes related to resource consumption and process of care; secondary outcomes related to clinical events. A questionnaire was completed by the surgeons participating in transports to document perceptions and preferences about means of in-hospital transport.

RESULTS:

Of 178 patients enrolled, 85 (48%) were in the LSTAT and 93 (52%) in the conventional groups. The two groups were similar except for age and mechanism of injury. Time of hand-bagging, preparation for transport, and return of blood results was significantly shorter in the LSTAT than in the conventional group (p < 0.001 for all). Significantly fewer LSTAT than conventional transports required more than one escorting physician (p < 0.001). Significantly more surveyed surgeons preferred LSTAT to conventional methods to transfer patients. There were no differences in adverse events, hospital stay, or mortality between the two groups.

CONCLUSIONS:

LSTAT emerges as a safe and convenient method of in-hospital transport. It allows uninterrupted monitoring, immediate response to physiologic changes, and reduction in human resource consumption. Process of care is improved. LSTAT's potential to improve clinical outcomes needs to be tested in different environments, including the prehospital setting.

 LSTAT™ (Life Support for Trauma and Transport)

LSTAT Manual pdf

Clinical evaluation of the Life Support for Trauma and Transport (LSTAT) platform

Johnson K, Pearce F, Westenskow D, Ogden LL, Farnsworth S, Peterson S, White J, Slade T - Crit Care (2002)

Bottom Line: The LSTAT contains conventional medical equipment that has been integrated into one platform and reduced in size to fit within the dimensional envelope of a North Atlantic Treaty Organization (NATO) stretcher.Our hypothesis was that the LSTAT would be equivalent to conventional equipment in detecting and treating life-threatening problems.Thirty-one anesthesiologists and recovery room nurses compared the LSTAT with conventional monitors while managing four simulated critical events.Questionnaires about aspects of LSTAT functionality were completed by nine nurses who cared for the patients placed on the LSTAT.In all of the simulations, there was no clinically significant difference in the time to diagnosis or treatment between the LSTAT and conventional equipment.

Affiliation: Department of Anesthesiology, University of Utah School of Medicine, Salt Lake City, USA. kjohnson@remi.med.utah.edu

Abstract: The Life Support for Trauma and Transport (LSTAT trade mark ) is a self-contained, stretcher-based miniature intensive care unit designed by the United States Army to provide care for critically injured patients during transport and in remote settings where resources are limited. The LSTAT contains conventional medical equipment that has been integrated into one platform and reduced in size to fit within the dimensional envelope of a North Atlantic Treaty Organization (NATO) stretcher. This study evaluated the clinical utility of the LSTAT in simulated and real clinical environments. Our hypothesis was that the LSTAT would be equivalent to conventional equipment in detecting and treating life-threatening problems.Thirty-one anesthesiologists and recovery room nurses compared the LSTAT with conventional monitors while managing four simulated critical events. The time required to reach a diagnosis and treatment was recorded for each simulation. Subsequently, 10 consenting adult patients were placed on the LSTAT after surgery for postoperative care in the recovery room. Questionnaires about aspects of LSTAT functionality were completed by nine nurses who cared for the patients placed on the LSTAT.In all of the simulations, there was no clinically significant difference in the time to diagnosis or treatment between the LSTAT and conventional equipment. All clinicians reported that they were able to manage the simulated patients properly with the LSTAT. Nursing staff reported that the LSTAT provided adequate equipment to care for the patients monitored during recovery from surgery and were able to detect critical changes in vital signs in a timely manner.Preliminary evaluation of the LSTAT in simulated and postoperative environments demonstrated that the LSTAT provided appropriate equipment to detect and manage critical events in patient care. Further work in assessing LSTAT functionality in a higher-acuity environment is warranted.

The LSTAT™ (Life Support for Trauma and Transport) head fairing.
Mentions: The LSTAT (model number 9602, Integrated Medical Systems, Inc, Signal Hill, CA, USA) consists of a pan and a stretcher. The pan contains commercially available equipment that has been reconfigured to fit in the 5-inch-deep (13-cm-deep) pan (Fig. 1). The pan fits beneath and is attached to a NATO stretcher and has a head fairing that extends 7 inches above the stretcher (Fig. 2). This equipment includes a transport ventilator, a 480-liter oxygen tank, a three-channel infusion pump, a defibrillator, a blood gas and blood chemistry analyzer, a suction device, a vital signs monitor, a computer, a power converter, and a battery power supply. The computer within the LSTAT continuously transmits physiologic data over a wireless network to a fixed large display called the clinical display and to a handheld notebook-computer-based display called the secondary display.