Improved Oxygenation After Transport in Patients With Hypoxemic Respiratory Failure

et al. 2020

Preprint

Background: Mechanical ventilation in helicopter emergency medical service (HEMS) environments is a procedure which carries a significant risk of complications. Limited data on the quality and performance of mechanical ventilation in HEMS are available in the literature.Method: We conducted an international survey to evaluate mechanical ventilation infrastructure in HEMS and collect data of transported ventilated patients. From June 20-22, 2019, the participating HEMS bases were asked to provide data via a web-based platform. Vital parameters and ventilation settings of the patients at first patient contact and at handover were compared using non-parametric statistical tests. Results: Out of 215 invited HEMS bases, 53 responded. Respondents were from Germany, Denmark, United Kingdom, Luxembourg, Austria and Switzerland. Of the HEMS bases, all teams were physician staffed, mainly anesthesiologists (79%), the majority were board certified (92.5%) and trained in intensive care medicine (89%) and had a median (range) experience in HEMS of 9 (0-25) years. HEMS may provide a high level of expertise in mechanical ventilation whereas the majority of ventilators are able to provide pressure controlled ventilation and continuous positive airway pressure modes (77%). Data of 30 ventilated patients with a median (range) age of 54 (21-100) years and 53% male gender were analyzed. Of these, 24 were primary missions and 6 interfacility transports. At handover, oxygen saturation (p<0.01) and positive end-expiratory pressure (p=0.04) of the patients were significantly higher compared to first patient contact.Conclusion: In this survey, the management of ventilated HEMS-patients was not associated with ventilation related serious adverse events. Patient conditions, training of medical crew and different technical and environmental resources are likely to influence management. Further studies are necessary to assess safety and process quality of mechanical ventilation in HEMS.Trial Registration: The survey was prospectively registered at Research Registry (researchregistry2925).

Section: Discussionsupporting

confidence: 83%

Mechanical ventilation of patients in helicopter emergency medical service transport: An international survey.

et al. 2020

Preprint

“…In general, there are only few studies on the process quality of mechanical ventilation in HEMS environments (4,5,9,10). Key results of our small study sample demonstrate that participating HEMSteams were entirely physician-staffed and provided a high expertise in critical care management and long experience in HEMS.…”

Section: Discussionmentioning

confidence: 85%

“…Across multiple studies, critical care transport teams with training in complex ventilator management are associated with improved PaO2 after transfer (9,10,12). The transporting team changed ventilator settings during transport in most patients (decreasing tidal volume, increasing PEEP, and increasing FiO2).…”

Section: Discussionmentioning

confidence: 99%

Mechanical ventilation of patients in helicopter emergency medical service transport: An international survey

et al. 2020

Preprint

Background: Mechanical ventilation in helicopter emergency medical service (HEMS) environments is a procedure which carries a significant risk of complications. Limited data on the quality and performance of mechanical ventilation in HEMS are available in the literature. Method: We conducted an international survey to evaluate mechanical ventilation infrastructure in HEMS and collect data of transported ventilated patients. From June 20-22, 2019, the participating HEMS bases were asked to provide data via a web-based platform. Results: Fifty-three HEMS bases responded. Respondents were from Germany, Denmark, United Kingdom, Luxembourg, Austria and Switzerland. Of the HEMS bases, all medical team leaders were physicians, mainly anesthesiologists (79%), the majority were board certified (92.5%) and trained in intensive care medicine (89%) and had a median (range) experience in HEMS of 9 (0-25) years. HEMS may provide a high level of expertise in mechanical ventilation whereas the majority of ventilators are able to provide pressure controlled ventilation and continuous positive airway pressure modes (77%). Data of 30 ventilated patients with a median (range) age of 54 (21-100) years and 53% male gender were analyzed. Conclusion: In this pilot study, the management of ventilated HEMS-patients was not associated with ventilation related serious adverse events. Individual circumstances of patients, training of medical crew and different technical and environmental resources are likely to influence management. Further studies involving ventilated patients are necessary to assess safety and process quality of mechanical ventilation in HEMS.

Section: Discussionmentioning

confidence: 87%

Mechanical ventilation of patients in helicopter emergency medical service transport: An international survey.

et al. 2020

Preprint

Background: Mechanical ventilation in helicopter emergency medical service (HEMS) environments is a procedure which carries a significant risk of complications. Limited data on the quality and performance of mechanical ventilation in HEMS are available in the literature.Method: We conducted an international survey to evaluate mechanical ventilation infrastructure in HEMS and collect data of transported ventilated patients. From June 20-22, 2019, the participating HEMS bases were asked to provide data via a web-based platform. Vital parameters and ventilation settings of the patients at first patient contact and at handover were compared using non-parametric statistical tests. Results: Out of 215 invited HEMS bases, 53 responded. Respondents were from Germany, Denmark, United Kingdom, Luxembourg, Austria and Switzerland. Of the HEMS bases, all medical team leaders were physicians, mainly anesthesiologists (79%), the majority were board certified (92.5%) and trained in intensive care medicine (89%) and had a median (range) experience in HEMS of 9 (0-25) years. HEMS may provide a high level of expertise in mechanical ventilation whereas the majority of ventilators are able to provide pressure controlled ventilation and continuous positive airway pressure modes (77%). Data of 30 ventilated patients with a median (range) age of 54 (21-100) years and 53% male gender were analyzed. Of these, 24 were primary missions and 6 interfacility transports. At handover, oxygen saturation (p<0.01) and positive end-expiratory pressure (p=0.04) of the patients were significantly higher compared to first patient contact.Conclusion: In this survey, the management of ventilated HEMS-patients was not associated with ventilation related serious adverse events. Patient conditions, training of medical crew and different technical and environmental resources are likely to influence management. Further studies are necessary to assess safety and process quality of mechanical ventilation in HEMS.Trial Registration: The survey was prospectively registered at Research Registry (researchregistry2925).