Noninvasive Mechanical Ventilation in Helicopter Emergency Medical Services Saves Time and Oxygen and Improves Patient and Mission Safety: A Pilot Study

Garrote, José Ignacio; Aylagas, Diego; Gutiérrez, José Marı́a; Sinisterra, Juan A.; Gowran, Brian Mc; Medina, Alberto; Díaz-Tendero, Javier; Gómez-Calcerrada, Pablo; Crespo, Ricardo

doi:10.1016/j.amj.2015.02.008

Cited by 7 publications

(11 citation statements)

References 16 publications

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“…An Australian case series looking at interhospital NIV reported 3/29 patients had cardiorespiratory collapse during transport. 10 In contrast, the evidence from this study suggests NIV can be used successfully on road, fixed wing and rotary wing platforms. The anecdotal experience of our retrieval physicians suggests a high degree of vigilance and an awareness of the limitations of NIV therapy are necessary for success.…”

Section: Discussionmentioning

confidence: 57%

“…Careful patient selection is essential in order to avoid adverse outcomes. 10 Selection should be based on local protocols and senior advice. ▸ Equipment factors-Not all transport ventilators provide adequate and effective NIV.…”

Section: Discussionmentioning

confidence: 99%

“…Mask air leak can cause increased flow and therefore decreased operation time. A recent small case series of NIV transport showed a mean oxygen consumption of 232.2 L. 10 ▸ Aviation considerations-Aviation factors such as transport distance, vehicle space, weight restrictions and patient access should always be considered. In this study, six patients were transported by rotary wing with ongoing NIV without complication.…”

Section: Discussionmentioning

confidence: 99%

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Management of critical illness with non-invasive ventilation by an Australian HEMS

2016

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BackgroundNon-invasive ventilation (NIV) therapy is widely used for the management of acute respiratory failure. The objective of this study was to investigate the current use of NIV during interhospital retrievals in an Australian physician-led aeromedical service.MethodsWe reviewed patients receiving NIV during interhospital retrieval at the Greater Sydney Area Helicopter Medical Services (GSA-HEMS) over a 14-month period. The main objectives were to describe the number of retrievals using NIV, the need for intubation in NIV patients and the effect of the therapy on mission duration.ResultsOver the study period, 3018 missions were reported; 106 cases (3.51%) involved administration of NIV therapy during the retrieval. The most common indication for NIV was pneumonia (34.0%). 86/106 patients received a successful trial of NIV therapy prior to interhospital transfer. 58 patients were transferred on NIV, while 28 patients had NIV removed during transport. None of these 86 patients required intubation or died, although 17/86 ultimately required intubation within 24 hours at the receiving centre. 20/106 patients required intubation at the referring hospital after a failed trial of NIV therapy. NIV was successfully used in all available transport platforms including rotary wing. Patients receiving NIV were found to have prolonged mission durations compared with other GSA-HEMS patients (222.5 vs 193 min). This increase in mission duration was largely attributable to NIV failure, resulting in a need for Rapid Sequence Intubation at the referring hospital.ConclusionsWith careful patient selection, the use of interhospital NIV is feasible and appears to be safe in a retrieval system with care provided by a critical care physician.

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Section: Discussionmentioning

confidence: 57%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Management of critical illness with non-invasive ventilation by an Australian HEMS

2016

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“…Moreover, systematic review and meta-analysis conducted by Hui et al, [36] reported no differences in mortality, intubation rate, and length of stay in the hospital between Bi-PAP and CPAP. However, some studies [33,37] reported (47%) reduction in mortality rate [33] and no endotracheal intubation [37] among ACPE patient who treated with NIV.…”

Section: Discussionmentioning

confidence: 99%

Bi-level Versus Continuous Positive Airway Pressure in Acute Cardiogenic Pulmonary Edema: A Randomized Control Trial

El-Refay¹

2015

CMR

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Abstract:This study was to compare the efficacy of continuous, bi-level positive airway pressure (CPAP, Bi-PAP) and oxygen therapy on detailed observation of time-course change in blood gases, physiological parameters and rate of endotracheal intubation in patient with acute cardiogenic pulmonary edema (ACPE). Sixty-six patients with ACPE were randomly assigned to receive standard oxygen (O 2 ) therapy (n=23), CPAP (n=21), and Bi-PAP (n=22). Blood gases (PaCO 2 , PaO 2 , SaO 2 , pH, and HCO 3 ), and physiological parameters (HR, RR, SBP, and DBP) were collected at baseline (T0), immediately after 60 minutes (T60), and after 30 minutes of discontinuation (T90). A significant improvements (p<0.05) in PaCO 2 , PaO 2 , SaO 2 and vital signs were observed immediately after CPAP and Bi-PAP when compared to O 2 therapy. After 30 minutes of disconnection, Bi-PAP revealed significant improvement (p<0.05) in PaO 2 , SaO 2 , and respiratory rate. No differences on intubation and death rate detected among treatment groups. Both methods of noninvasive ventilations are effective treatment for ACPE. However, Bi-PAP should be considered as first line of treatment due to faster and continuous improvement in oxygenation and respiratory rate.

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“…14 Another trial compared NIV use with standard care for COPD and pulmonary oedema and concluded it was safe and time efficient; however, it too had a small sample size. 15 Lastly, a retrospective cohort analysis evaluated the use of NIV in the retrieval setting, but only a small number of patients were being transferred by air. 16 Thus, there exists a gap in the evidence base around the use of CPAP/ NIV in the aeromedical retrieval setting.…”

Section: Introductionmentioning

confidence: 99%

Use of continuous positive airway pressure and non‐invasive ventilation for respiratory failure in an Australian aeromedical retrieval service: A retrospective case series

Weller¹,

Gibbs²,

Pellatt³

et al. 2021

Emerg Medicine Australasia

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Objective: The purpose of the present study was to investigate the use of respiratory support via continuous positive airway pressure (CPAP) and noninvasive ventilation (NIV) in a medical retrieval service in Queensland, Australia, with reference to transport considerations and patient safety. Methods: In this unblinded retrospective case series over a 13-month period, a clinical database was reviewed for the use of CPAP/NIV. Retrieval metrics as well as clinical data were recorded. Results: A total of 128 patients were transferred either by rotary (80%) or fixed wing (20%). The median transport time was 65 min. The median total mission time was 3.7 h. Fifty-two percent of patients were female. The median age was 69 years and 93% had a background of cardiorespiratory disease. Sixty-five percent of patients were receiving CPAP/NIV before arrival of the retrieval team. The main diagnoses were respiratory failure (29.7%), acute pulmonary oedema (26.6%) and chronic obstructive pulmonary disease (25.8%). There were no incidences of pneumothorax, intubation in transit, vomiting, desaturation, hypotension, cardiac arrest or death. In two cases NIV was abandoned due to mask intolerance and in one case there was a decrease in Glasgow Coma Scale by 2. In no cases was there a detrimental outcome for the patient. Conclusion: The use of NIV and CPAP appears to have a low-risk profile in aeromedical retrieval even for prolonged periods of time in an adult population.

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Noninvasive Mechanical Ventilation in Helicopter Emergency Medical Services Saves Time and Oxygen and Improves Patient and Mission Safety: A Pilot Study

Cited by 7 publications

References 16 publications

Management of critical illness with non-invasive ventilation by an Australian HEMS

Management of critical illness with non-invasive ventilation by an Australian HEMS

Bi-level Versus Continuous Positive Airway Pressure in Acute Cardiogenic Pulmonary Edema: A Randomized Control Trial

Use of continuous positive airway pressure and non‐invasive ventilation for respiratory failure in an Australian aeromedical retrieval service: A retrospective case series

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