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Effect of Air Transport Delay on Mortality in Critical Illness: A Population-Based Cohort Study

Published:October 13, 2022DOI:https://doi.org/10.1016/j.amj.2022.09.001

      Highlights

      • Air transport delay from remote areas may affect mortality in critical illness.
      • We evaluated fixed wing air ambulance transport of unselected patients to the nearest intensive care unit.
      • Thirty-day mortality ranged from 11% better to 22% worse for each 1 hour of delay.
      • There is a need for additional, larger studies on this topic.

      Abstract

      Objective

      For critically ill patients in remote areas, we assessed the association of transport delay via fixed wing air ambulance on 30-day mortality, excluding interhospital transports.

      Methods

      This was a retrospective cohort analysis of all such adult transports in Manitoba, Canada, over 5.4 years. Causal mediation analysis was used, with the Acute Physiology and Chronic Health Evaluation II Acute Physiology Score at the destination intensive care unit as the mediator. The covariates were age, sex, comorbidities, socioeconomic status, and physiologic variables from the sending site.

      Results

      The primary cohort was composed of 554 patients; 113 (20.4%) died within 30 days. The total transport delay (mean ± standard deviation) was 5.1 ± 1.7 hours. Compared with no delay, the average 5-hour transport delay was associated with an odds ratio for mortality of 1.34 with a 95% confidence interval from 40% lower to 270% higher, with 60% of the influence of total travel time attributable to worsening of patients’ acute physiologic status during the delay in intensive care unit admission due to transport.

      Conclusions

      Although these findings provide insufficient evidence for an effect of fixed wing air transport delay on mortality among critically ill patients, they underscore the need for additional and larger studies on this topic.
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