Mechanical ventilation of patients in helicopter emergency medical service transport: An international survey.
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).
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Posted 18 Sep, 2020
On 18 Nov, 2020
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Received 27 Aug, 2020
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On 23 Jul, 2020
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Received 09 Jul, 2020
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Invitations sent on 29 Jun, 2020
On 01 Jun, 2020
On 31 May, 2020
On 31 May, 2020
On 30 May, 2020
Mechanical ventilation of patients in helicopter emergency medical service transport: An international survey.
Posted 18 Sep, 2020
On 18 Nov, 2020
On 29 Sep, 2020
On 17 Sep, 2020
On 16 Sep, 2020
On 16 Sep, 2020
Invitations sent on 27 Aug, 2020
On 27 Aug, 2020
On 27 Aug, 2020
Received 27 Aug, 2020
Received 27 Aug, 2020
On 10 Aug, 2020
On 09 Aug, 2020
On 09 Aug, 2020
On 23 Jul, 2020
On 14 Jul, 2020
Received 14 Jul, 2020
Received 09 Jul, 2020
On 06 Jul, 2020
Invitations sent on 29 Jun, 2020
On 01 Jun, 2020
On 31 May, 2020
On 31 May, 2020
On 30 May, 2020
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).