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

Abstract

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.

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

“…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.…”

“…Recent studies suggested that real-world handling of these high-risk patients may differ from desirable standards and often depends on the discretion of the attending HEMS team (4)(5)(6).…”