Highlights
- •Transport ventilators have technical limitations on peak inspiratory pressures.
- •The patient's current ventilator settings must be considered before the launch of an aircraft.
- •Extracorporeal membrane oxygenation should be considered in cases of status asthmaticus and cardiovascular collapse.
- •There may be some utility in considering alternative “rescue” modes of ventilation during transport.
Abstract
The air medical transport of intubated patients is a high-risk mission that requires
preplanning before helicopter launch. This case describes a scenario in which the
helicopter emergency medical services (HEMS) team was unable to ventilate a patient
because of the mechanical limitations of the transport ventilator. The HEMS mission
was ultimately aborted, and the patient had to be transported by a ground crew equipped
with a hospital-based ventilator. In addition to the optimal medical management of
the patient in status asthmaticus, critical care transport crews must be familiar
with the treatment of patients exhibiting extremely high peak airway pressures. Specifically,
ventilator manipulations as well as the technical specifications of the transport
ventilator may preclude the patient from being transported by the HEMS team. It is
imperative that the patient's current ventilator setting be evaluated before the launch
of the aircraft to prevent any possible delays in patient care.
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References
- Rates and characteristics of intensive care unit admissions and intubations among asthma-related hospitalizations.Ann Allergy Asthma Immunol. 2004; 93: 29-35
- Management of severe asthma exacerbation: guidelines from the Société Française de Médecine d'Urgence, the Société de Réanimation de Langue Française and the French Group for Pediatric Intensive Care and Emergencies.Ann Intensive Care. 2019; 9: 115
- Review article: management of acute severe and near-fatal asthma.Emerg Med Australas. 2009; 21: 259-268
- Tunnicliffe. Management of life-threatening asthma in adults.Contin Educ Anaesth Crit Care Pain. 2008; 8: 95-99
- Clinical review: severe asthma.Crit Care. 2002; 6: 30-44
- Severe refractory asthma: an update.Eur Respir Rev. 2013; 22: 227-235
Farkas J. Asthma. Available at: https://emcrit.org/ibcc/asthma/. Published October 29, 2019. Accessed August 16, 2020.
- REBEL Cast Episode 11: The Crashing Asthmatic.REBEL EM blog. June 1, 2015; (Available at:) (Accessed Augest 16, 2020)
- Asthma.in: Marx JA Hockberger RS Walls RM Rosen's Emergency Medicine: Concepts and Clinical Practice. 8th ed. Mosby, Inc, St Louis, MO2014: 941-958
- Core EM: life-threatening asthma.2015 (Published October 21,Accessed August 16, 2020)
- Intravenous epinephrine in life-threatening asthma.Ann Emerg Med. 2003; 41: 706-711
- Ketamine in status asthmaticus: a review.Indian J Crit Care Med. 2013; 17: 154-161
- Medication regimens for managing acute asthma.Respir Care. 2018; 63: 783-796
- Does intravenous magnesium reduce the need for hospital admission among adult patients with acute asthma exacerbations.Ann Emerg Med. 2015; 65: 702-703
- Intravenous or nebulized magnesium sulphate versus standard therapy for severe acute asthma (3Mg trial): a double-blind, randomised controlled trial.Lancet Respir Med. 2013; 1: 293-300
- A pilot prospective, randomized, placebo-controlled trial of bilevel positive airway pressure in acute asthmatic attack.Chest. 2003; 123: 1018-1025
- Non-invasive positive pressure ventilation for treatment of respiratory failure due to severe acute exacerbations of asthma.Cochrane Database Syst Rev. 2005; 3CD004360
- The use of heliox in critical care.Int J Crit Illn Inj Sci. 2014; 4: 138-142
- Adjunct therapies for refractory status asthmaticus in children.Respir Care. 2017; 62: 849-865
- Mechanically ventilating the severe asthmatic.J Intensive Care Med. 2018; 33: 491-501
- A protocol for helicopter in-cabin intubation.Air Med J. 2018; 37: 306-311
- Prehospital anaesthesia performed in a rural and suburban air ambulance service staffed by a physician and paramedic: a 16-month review of practice.Emerg Med J. 2014; 31: 65-68
- Observational study of the success rates of intubation and failed intubation airway rescue techniques in 7256 attempted intubations of trauma patients by pre-hospital physicians.Br J Anaesth. 2014; 113: 220-225
- Scandinavian SSAI clinical practice guideline on pre-hospital airway management.Acta Anaesthesiol Scand. 2016; 60: 852-864
- Recommended practice for out-of-hospital emergency anaesthesia in adults: statement from the Out-of-Hospital Emergency Anaesthesia Working Group of the Emergency Medicine Research Group of the German Society of Anaesthesiology and Intensive Care.Eur J Anaesthesiol. 2016; 33: 881-897
Hamilton T1 Transport Ventilator technical specification. Available at: https://www.hamilton-medical.com/en_US/Landingpages/HAMILTON-T1.html. Accessed August 16, 2020.
- Clinical review: mechanical ventilation in severe asthma.Crit Care. 2005; 9: 581-587
- Is there a role of applied PEEP (PEEPe) in controlled mechanically ventilated severe asthma exacerbations?.in: Paper presented at: American Thoracic Society International Conference, San Diego, CA2018 (May 22. Available at:) (Accessed Augest 17, 2020.)
- Pattern of lung emptying and expiratory resistance in mechanically ventilated patients with chronic obstructive pulmonary disease.Intensive Care Med. 2004; 30: 1311-1318
- Early application of airway pressure release ventilation may reduce the duration of mechanical ventilation in acute respiratory distress syndrome.Intensive Care Med. 2017; 43: 1648-1659
- The 30-year evolution of airway pressure release ventilation (APRV).Intensive Care Med Exp. 2016; 4: 11
- Ventilating patient with refractory hypercarbia: use of APRV mode.J Clin Diagn Res. 2016; 10 (UD01-UD2)
Article info
Publication history
Published online: December 15, 2020
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