Collective aeromedical evacuations of SARS-CoV-2-related ARDS patients in a military tactical plane: a retrospective descriptive study

Abstract

After the appearance of the COVID-19 pandemic in France, MEROPE system was created to transform the military tactical ATLAS A400M aircraft into a flying intensive care unit. Collective aeromedical evacuations (aero-MEDEVAC) of patients suffering from SARS-CoV-2-related acute respiratory distress syndrome was performed from June to December 2020. A total of 22 patients were transported during seven missions. All aero-MEDEVAC was performed in safe conditions for patients and crew. No life-threatening conditions occurred during flight. Biohazard controls were applied according to French guidelines and prevented crew contamination. Thanks to rigorous selection criteria and continuous in-flight medical care, the safe transportation of these patients was possible. To the best of our knowledge, this is the first description of collective aero-MEDEVAC of these kinds of patients using a tactical military aircraft. We here describe the patient’s characteristics and the flight’s challenges.

Severe Acute Respiratory Syndrome Coronavirus 2 and Medical Evacuation in Lombardy: Lessons Learned from an Unprecedented Pandemic

“…The high percentage of male patients evacuated from Lombardy reflects the results of other similar studies conducted in this region 20,21 and is also in line with other similar research. 10,13,14,18,22 Also, the median age of patients transferred was similar to that described by Grasselli et al 20 and Ciceri et al 21 The mortality rate (28%) was lower when compared with that described for mechanically ventilated patients in Lombardy; 23 this could be explained by the restrictive eligibility criteria applied in this study. Furthermore, even if there was a weak association, in terms of higher mortality, for patients evacuated to Germany when compared to those transferred to other Italian regions, these data must be interpreted with caution since these results might be highly influenced by the evolution of the disease itself, patient comorbidities, and local treatment guidelines.…”

“…Several studies have described MEDEVAC missions for hundreds of COVID-19 patients, most of them reporting MEDEVAC operations at the national level. [10][11][12][13][14] However, most of these studies focused on the clinical characteristics of evacuated patients 10,13,14 with only 2 of them mentioning organizational aspects and patient outcomes after repatriation. 11,12 This manuscript provided an overview of the complex functional and hierarchical liaisons rapidly put in place by the region of Lombardy in the most critical moment of the COVID-19 health crisis in Italy.…”

“…This is well reflected in our study but also in recent MEDEVAC reports where transport eligibility criteria depended on discussion groups rather relying upon collectively endorsed guidelines. [10][11][12][13][14] Lemay et al suggested the early transfer of ARDS patients before refractory hypoxemia occurs as it may prevent the need for complex respiratory procedures during evacuation. 19 At the same time, these patients could be more likely to survive than others with longer time of mechanical ventilation or needing higher oxygen supplies.…”

“…This study was able to track patients after repatriation, which still represents a limitation in most published research. 10,[12][13][14] Data on the outcome of critically ill patients after long-distance transportation are crucial to draw conclusions on the adequacy of patient selection and assess whether MEDEVAC missions are worth implementing, in reference to the risk of infection transmission for transport health staff, bureaucratic and diplomatic hurdles, and resource consumption.…”