Long-distance transport of ventilated patients: Advantages and limitations of air medical repatriation on commercial airlines

doi:10.1016/j.amj.2003.12.009

Air Medical Journal

Volume 23, Issue 2, March–April 2004, Pages 24-28

https://doi.org/10.1016/j.amj.2003.12.009 Get rights and content

Abstract

Introduction

To illustrate the advantages and limitations of transporting ventilated intensive care unit patients over intercontinental distances on commercial airlines, this case series reports 8 ventilated patients repatriated by an air medical transport company.

Patients

Eight ventilated patients, 3 suffering from internal and 5 from neurologic diseases. Distances ranged from 1700 to 10280 nautical miles with transport times from 04:10 hours to 21:55 hours. For 3 patients, a dedicated patient transport compartment (PTC) in the aircraft cabin was used. All patients were ventilator-dependent for a minimum of 11 days before transport (48 days median, 113 days maximum).

Results

One patient went into cardiac arrest during the flight and died. None of the other patients experienced any emergency or invasive procedures, other than peripheral venous access necessary during the flight. In all patients, ventilation was adjusted with respect to the blood gas analysis at least once during the transport. No technical failures or drop-outs occurred during the flights. None of the flights had to be diverted for technical or medical reasons.

Conclusion

Long distance international transport of ventilated intensive care unit patients is an extremely cost intensive and logistically challenging task. In a certain subgroup of relatively stable ventilated patients, transport on commercial airlines offers advantages in terms of cost effectiveness and reduced transport time and acceleration/deceleration trauma as a result of multiple fuel stops.

Introduction

Travel for business or recreational purposes is increasingly taking people away from their home countries. If those travelers fall ill abroad, repatriation becomes necessary. During the past decades, the travel insurance industry has provided the traveler with cost coverage for treatment abroad and repatriation to the home country.¹ Whereas slight to moderately ill or injured patients commonly are transported seated or on a stretcher on commercial airlines, critical care patients, especially if ventilated, usually require dedicated air ambulance (AA) jets for air medical transport (Figure 1).

These aircraft, however, are extremely costly—up to €5000 Euro ($6100 US dollars) per hour on long-distance intercontinental flights and demand frequent stops for refueling, which represent an additional burden for the patient because of pressure changes and acceleration/deceleration forces.² Therefore, the transport of stable and ventilated critical care patients using commercial airlines represents a cost-effective and useful alternative to AA on long intercontinental flights (Figure 2).

Section snippets

Patients

The cases of ventilated patients are reported who were transported ventilated on commercial airlines by the air medical transport company Med Call in Wiesbaden, Germany. Patients eligible for transport were not in acute respiratory failure, had an oxygenation index ( $F io_{2} × Mean Airway Pressure (PAW) / Pa o_{2} × 100$ )3, 4 below 10 while the transport was planned, and were not on high-dose inotropic support. The feasibility of transport on a commercial airliner was discussed before all transport

Methods

All patients were accompanied by a physician and nurse. All medical team members had several years of experience in intensive care and air medical medicine and were licensed by the German Medical Association. The transport team arrived in the referring hospital 1 day before transport to examine the patient and test compliance with the transport ventilator.

Equipment

A Mallinckrodt Achieva PS Ventilator (Mallinckrodt, Hazelwood, Missouri, USA) was used for all but 2 transports; those patients were ventilated with a Draeger EV 801 (Draeger Medizintechnik, Luebeck, Germany) or a Breas LTV 1000 (Breas, Mälnlycke, Sweden). A portable blood gas analyzer (Abbott I-STAT Portable Clinical Analyzer, Abbott Laboratories, East Windsor, New Jersey, USA) was used for point-of-care testing during all transports. Patients were monitored with a Siemens Sirecust SC6002

Results

Eight patients were transported. Patient characteristics, diagnoses, and routes are summarized in Table 1. Almost all patients were repatriated because of acute illness or injury while they were abroad on holiday or as expatriates. One patient (no. 8) was repatriated after being transferred abroad for specialist diagnostics and treatment. One additional patient, suffering from intracranial hemorrhage, was planned to be transferred from South Africa to Great Britain, but the airline withdrew the

Discussion

If a person falls ill abroad and needs critical care treatment, repatriation to the country of origin becomes increasingly difficult. Almost all patients who depend on a ventilator are transported by AA; only 2 reports5, 6 could be found of transports of a ventilated patient on commercial airlines. Although ambulance jets represent a reasonable mode of transport for short and mid-range distances, long-distance transports show some significant drawbacks. Costs increase dramatically on

Conclusion

Long-distance international transport of ventilated critically ill patients is an extremely cost-intensive and logistically challenging task. In a certain subgroup of relatively stable long-term ventilated patients, transport on commercial airlines offers advantages in terms of cost-effectiveness and reduced transport times and acceleration/deceleration trauma from multiple fuel stops.

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Peer ReviewedLong-distance transport of ventilated patients: Advantages and limitations of air medical repatriation on commercial airlines

Abstract

Introduction

Patients

Results

Conclusion

Introduction

Section snippets

Patients

Methods

Equipment

Results

Discussion

Conclusion

Ann Emerg Med

Medical assistance to travellers: a new concept in insurance—cooperation with an airline

Aviat Space Environ Med

Heart rate responses to moderate linear body accelerations: clinical implications in aeromedical evacuation

Aviat Space Environ Med

Oxygenation index, an indicator of optimal distending pressure during high-frequency oscillatory ventilation?

Intensive Care Med

Oxygenation index in patients with meconium aspiration: conventional and extracorporeal membrane oxygenation therapy

Crit Care Med

Peer Reviewed
Long-distance transport of ventilated patients: Advantages and limitations of air medical repatriation on commercial airlines