1
|
Pinto-Villalba RS, Leon-Rojas JE. Reported adverse events during out-of-hospital mechanical ventilation and ventilatory support in emergency medical services and critical care transport crews: a systematic review. Front Med (Lausanne) 2023; 10:1229053. [PMID: 37877027 PMCID: PMC10590890 DOI: 10.3389/fmed.2023.1229053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 09/20/2023] [Indexed: 10/26/2023] Open
Abstract
Background Emergency medical services (EMS) and critical care transport crews constantly face critically-ill patients who need ventilatory support in scenarios where correct interventions can be the difference between life and death; furthermore, challenges like limited staff working on the patient and restricted spaces are often present. Due to these, mechanical ventilation (MV) can be a support by liberating staff from managing the airway and allowing them to focus on other areas; however, these patients face many complications that personnel must be aware of. Aims To establish the main complications related to out-of-hospital MV and ventilatory support through a systematic review. Methodology PubMed, BVS and Scopus were searched from inception to July 2021, following the PRISMA guidelines; search strategy and protocol were registered in PROSPERO. Two authors carried out an independent analysis of the articles; any disagreement was solved by mutual consensus, and data was extracted on a pre-determined spreadsheet. Only original articles were included, and risk of bias was assessed with quality assessment tools from the National Institutes of Health. Results The literature search yielded a total of 2,260 articles, of which 26 were included in the systematic review, with a total of 9,418 patients with out-of-hospital MV; 56.1% were male, and the age ranged from 18 to 82 years. In general terms of aetiology, 12.2% of ventilatory problems were traumatic in origin, and 64.8% were non-traumatic, with slight changes between out-of-hospital settings. Mechanical ventilation was performed 49.2% of the time in prehospital settings and 50.8% of the time in interfacility transport settings (IFTS). Invasive mechanical ventilation was used 98.8% of the time in IFTS while non-invasive ventilation was used 96.7% of the time in prehospital settings. Reporting of adverse events occurred in 9.1% of cases, of which 94.4% were critical events, mainly pneumothorax in 33.1% of cases and hypotension in 27.6% of cases, with important considerations between type of out-of-hospital setting and ventilatory mode; total mortality was 8.4%. Conclusion Reported adverse events of out-of-hospital mechanical ventilation vary between settings and ventilatory modes; this knowledge could aid EMS providers in promptly recognizing and resolving such clinical situations, depending on the type of scenario being faced.
Collapse
Affiliation(s)
- Ricardo Sabastian Pinto-Villalba
- Carrera de Atención Prehospitalaria y en Emergencias, Universidad Central del Ecuador, Quito, Ecuador
- Facultad de Medicina, Carrera de Atención Prehospitalaria y en Emergencias, Universidad UTE, Quito, Ecuador
- Medignosis, Medical Research Department, Quito, Ecuador
| | | |
Collapse
|
2
|
Weller M, Gibbs C, Pellatt R, MacKillop A. Use of continuous positive airway pressure and non-invasive ventilation for respiratory failure in an Australian aeromedical retrieval service: A retrospective case series. Emerg Med Australas 2021; 33:1001-1005. [PMID: 33855803 DOI: 10.1111/1742-6723.13779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 03/15/2021] [Accepted: 03/29/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The purpose of the present study was to investigate the use of respiratory support via continuous positive airway pressure (CPAP) and non-invasive 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.
Collapse
Affiliation(s)
- Martin Weller
- Department of Clinical Operations, LifeFlight Australia, Brisbane, Queensland, Australia
| | - Clinton Gibbs
- Office of the Clinical Director (Northern Operations), Retrieval Services Queensland, Townsville, Queensland, Australia
| | - Richard Pellatt
- Department of Clinical Operations, LifeFlight Australia, Brisbane, Queensland, Australia
| | - Allan MacKillop
- Department of Clinical Operations, LifeFlight Australia, Brisbane, Queensland, Australia
| |
Collapse
|
3
|
King JC, Franklin RC, Robertson A, Aitken PJ, Elcock MS, Gibbs C, Lawton L, Mazur SM, Edwards KH, Leggat PA. Review article: Primary aeromedical retrievals in Australia: An interrogation and search for context. Emerg Med Australas 2019; 31:916-929. [PMID: 31729193 DOI: 10.1111/1742-6723.13405] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2019] [Revised: 08/07/2019] [Accepted: 09/20/2019] [Indexed: 11/28/2022]
Abstract
Primary aeromedical retrievals are a direct scene response to patients with a critical injury or illness using a medically equipped aircraft. They are often high-acuity taskings. In Australia, information on primary retrieval taskings is housed by service providers, of which there are many across the country. This exploratory literature review aims to explore the contemporary peer-reviewed literature on primary aeromedical retrievals in Australia. The focus is on adult primary aeromedical retrievals undertaken in Australia and clinical tools used in this pre-hospital setting. Included articles were reviewed for research theme (clinical and equipment, systems and/or outcomes), data coverage and appraisal of the evidence. Of the 37 articles included, majority explored helicopter retrievals (n = 32), retrieval systems (n = 21), compared outcomes within a service (n = 10) and explored retrievals in the state of New South Wales (n = 19). Major topics of focus included retrieval of trauma patients and airway management. Overall, the publications had a lower strength of evidence because of the preponderance of cross-sectional and case-study methodology. This review provides some preliminary but piecemeal insight into primary retrievals in Australia through a localised systems lens. However, there are several areas for research action and service outcome improvements suggested, all of which would be facilitated through the creation of a national pre-hospital and retrieval registry. The creation of a registry would enable consideration of the frequency and context of retrievals, comparison across services, more sophisticated data interrogation. Most importantly, it can lead to service and pre-hospital and retrieval system strengthening.
Collapse
Affiliation(s)
- Jemma C King
- Discipline of Public Health and Tropical Medicine, College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Queensland, Australia
| | - Richard C Franklin
- Discipline of Public Health and Tropical Medicine, College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Queensland, Australia.,World Safety Organization Collaborating Centre for Disaster Health and Emergency Response, Townsville, Queensland, Australia
| | - Anita Robertson
- Discipline of Public Health and Tropical Medicine, College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Queensland, Australia.,Royal Flying Doctor Service, Townsville, Queensland, Australia
| | - Peter J Aitken
- Discipline of Public Health and Tropical Medicine, College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Queensland, Australia.,Aeromedical Retrieval and Disaster Management Branch, Prevention Division, Department of Health, Brisbane, Queensland, Australia
| | - Mark S Elcock
- Discipline of Public Health and Tropical Medicine, College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Queensland, Australia.,Aeromedical Retrieval and Disaster Management Branch, Prevention Division, Department of Health, Brisbane, Queensland, Australia
| | - Clinton Gibbs
- Retrieval Services Queensland, Aeromedical Retrieval and Disaster Management Branch, Prevention Division, Department of Health, Brisbane, Queensland, Australia.,College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia.,Department of Emergency Medicine, The Townsville Hospital, Townsville, Queensland, Australia
| | - Luke Lawton
- College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia.,Department of Emergency Medicine, The Townsville Hospital, Townsville, Queensland, Australia
| | - Stefan M Mazur
- Discipline of Public Health and Tropical Medicine, College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Queensland, Australia.,Department of Emergency Medicine, The Townsville Hospital, Townsville, Queensland, Australia.,SAAS MedSTAR Emergency Medical Retrieval Service, SA Ambulance Service, Adelaide, South Australia, Australia.,Emergency Department, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Kristin H Edwards
- Discipline of Public Health and Tropical Medicine, College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Queensland, Australia
| | - Peter A Leggat
- Discipline of Public Health and Tropical Medicine, College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Queensland, Australia.,World Safety Organization Collaborating Centre for Disaster Health and Emergency Response, Townsville, Queensland, Australia.,School of Public Health and Social Work, Queensland University of Technology, Brisbane, Queensland, Australia
| |
Collapse
|
5
|
Coggins AR, Cummins EN, Burns B. Management of critical illness with non-invasive ventilation by an Australian HEMS. Emerg Med J 2016; 33:807-811. [PMID: 27371641 PMCID: PMC5136697 DOI: 10.1136/emermed-2015-205377] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Revised: 06/08/2016] [Accepted: 06/10/2016] [Indexed: 11/04/2022]
Abstract
BACKGROUND Non-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. METHODS We 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. RESULTS Over 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. CONCLUSIONS With 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.
Collapse
Affiliation(s)
- Andrew R Coggins
- Department of Emergency Medicine, Westmead Hospital, Sydney, New South Wales, Australia
- Discipline of Emergency Medicine, The University of Sydney, Sydney, New South Wales, Australia
| | - Erin N Cummins
- Department of Emergency Medicine, Westmead Hospital, Sydney, New South Wales, Australia
| | - Brian Burns
- Discipline of Emergency Medicine, The University of Sydney, Sydney, New South Wales, Australia
- Ambulance Service of New South Wales, Greater Sydney Area HEMS, Sydney, New South Wales, Australia
| |
Collapse
|