Long-distance transport of ventilated patients: advantages and limitations of air medical repatriation on commercial airlines.
BACKGROUND
To illustrate the advantages and limitations of transporting ventilated intensive care unit patients over intercontinental distances on commercial airlines, this case series reports 8 ventilated patients repatriated by an air medical transport company.


METHODS
Eight ventilated patients, 3 suffering from internal and 5 from neurologic diseases. Distances ranged from 1700 to 10280 nautical miles with transport times from 04:10 hours to 21:55 hours. For 3 patients, a dedicated patient transport compartment (PTC) in the aircraft cabin was used. All patients were ventilator-dependent for a minimum of 11 days before transport (48 days median, 113 days maximum).


RESULTS
One patient went into cardiac arrest during the flight and died. None of the other patients experienced any emergency or invasive procedures, other than peripheral venous access necessary during the flight. In all patients, ventilation was adjusted with respect to the blood gas analysis at least once during the transport. No technical failures or drop-outs occurred during the flights. None of the flights had to be diverted for technical or medical reasons.


CONCLUSIONS
Long distance international transport of ventilated intensive care unit patients is an extremely cost intensive and logistically challenging task. In a certain subgroup of relatively stable ventilated patients, transport on commercial airlines offers advantages in terms of cost effectiveness and reduced transport time and acceleration/deceleration trauma as a result of multiple fuel stops.
Veldman
Alex
A
Department of Pediatrics, Division of Neonatology, Johann Wolfgang Goethe University Hospital, Theodor Stern Kai 7, 60590 Frankfurt/Main, Germany. alex.veldman@kgu.de
Diefenbach
Michael
M
Fischer
Doris
D
Benton
Alida
A
Bloch
Richard
R
D000328:Adult; D000368:Aged; D017732:Air Ambulances / Q000191:economics; D001359:Aviation / Q000191:economics*; D003132:Commerce; D003422:Critical Care / Q000191:economics* / Q000379:methods; D004864:Equipment and Supplies / Q000191:economics; D005260:Female; D005858:Germany; D017048:Health Care Costs; D006302:Health Services Research; D006801:Humans; D038622:Internationality; D008297:Male; D008875:Middle Aged; D010102:Oxygen Inhalation Therapy / Q000191:economics / Q000295:instrumentation; D014187:Transportation of Patients / Q000191:economics* / Q000379:methods*; D014195:Travel; D012122:Ventilators, Mechanical / Q000706:statistics & numerical data*