Air transport of patients with severe lung injury: Development and utilization of the acute lung rescue team

Gina R. Dorlac, Raymond Fang, Valerie M. Pruitt, Peter A. Marco, Heidi M. Stewart, Stephen L. Barnes, Warren C. Dorlac

Research output: Contribution to journalArticle

Abstract

BACKGROUND: Critical Care Air Transport Teams (CCATTs) are an integral component of modern casualty care, allowing early transport of critically ill and injured patients. Aeromedical evacuation of patients with significant pulmonary impairment is sometimes beyond the scope of CCATT because of limitations of the transport ventilator and potential for further respiratory deterioration in flight. The Acute Lung Rescue Team (ALRT) was developed to facilitate transport of these patients out of the combat theater. METHODS: The United States TRANSCOM Regulation and Command/Control Evacuation System and the United States Army Institute of Surgical Research Joint Theater Trauma Registry databases were reviewed for all critical patients transported out of theater between November 2005 and March 2007. Patient demographics, diagnosis, and clinical history were abstracted and ALRT patients were compared with CCATT patients. RESULTS: The ALRT was activated for 11 patients during the study period. Five patients were transported as a result of these activations. Trauma-related diagnoses were responsible for 82% of these requests. ALRT missions comprised 0.6% of all critical patient movements out of the combat theater and 1% of ventilator transports. Average FIO2 was 0.92 ± 0.11 for ALRT patients and 0.53 ± 0.14 for CCATT patients (p = 0.005). ALRT patients required a mean positive end expiratory pressure of 19.0 cm H2O ± 2.2 cm H2O compared with 6.5 cm H2O ± 2.4 cm H2O in the CCATT group (p = 0.002). CONCLUSIONS: Lung injury in the combat theater severe enough to exceed the capability of CCATT transport is uncommon. Patients for whom ALRT was activated had significantly higher positive end expiratory pressure and FIO2 than those transported by CCATT. One-fourth of patients for whom ALRT was considered died before the team could be launched; transport may have been a futile consideration in these patients. Patients with even severe acute respiratory distress syndrome can be successfully transported by experienced, equipped specialty teams.

Original languageEnglish (US)
JournalJournal of Trauma - Injury, Infection and Critical Care
Volume66
Issue numberSUPPL. 4
DOIs
StatePublished - Apr 1 2009
Externally publishedYes

Fingerprint

Lung Injury
Air
Lung
Critical Care
Positive-Pressure Respiration
Mechanical Ventilators
Severe Acute Respiratory Syndrome
Adult Respiratory Distress Syndrome
Wounds and Injuries
Critical Illness

Keywords

  • Acute lung injury
  • Acute lung rescue team
  • Aeromedical transport
  • CCATT
  • Military medicine
  • Novalung
  • War and patient transfer

ASJC Scopus subject areas

  • Surgery
  • Critical Care and Intensive Care Medicine

Cite this

Air transport of patients with severe lung injury : Development and utilization of the acute lung rescue team. / Dorlac, Gina R.; Fang, Raymond; Pruitt, Valerie M.; Marco, Peter A.; Stewart, Heidi M.; Barnes, Stephen L.; Dorlac, Warren C.

In: Journal of Trauma - Injury, Infection and Critical Care, Vol. 66, No. SUPPL. 4, 01.04.2009.

Research output: Contribution to journalArticle

Dorlac, Gina R. ; Fang, Raymond ; Pruitt, Valerie M. ; Marco, Peter A. ; Stewart, Heidi M. ; Barnes, Stephen L. ; Dorlac, Warren C. / Air transport of patients with severe lung injury : Development and utilization of the acute lung rescue team. In: Journal of Trauma - Injury, Infection and Critical Care. 2009 ; Vol. 66, No. SUPPL. 4.
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abstract = "BACKGROUND: Critical Care Air Transport Teams (CCATTs) are an integral component of modern casualty care, allowing early transport of critically ill and injured patients. Aeromedical evacuation of patients with significant pulmonary impairment is sometimes beyond the scope of CCATT because of limitations of the transport ventilator and potential for further respiratory deterioration in flight. The Acute Lung Rescue Team (ALRT) was developed to facilitate transport of these patients out of the combat theater. METHODS: The United States TRANSCOM Regulation and Command/Control Evacuation System and the United States Army Institute of Surgical Research Joint Theater Trauma Registry databases were reviewed for all critical patients transported out of theater between November 2005 and March 2007. Patient demographics, diagnosis, and clinical history were abstracted and ALRT patients were compared with CCATT patients. RESULTS: The ALRT was activated for 11 patients during the study period. Five patients were transported as a result of these activations. Trauma-related diagnoses were responsible for 82{\%} of these requests. ALRT missions comprised 0.6{\%} of all critical patient movements out of the combat theater and 1{\%} of ventilator transports. Average FIO2 was 0.92 ± 0.11 for ALRT patients and 0.53 ± 0.14 for CCATT patients (p = 0.005). ALRT patients required a mean positive end expiratory pressure of 19.0 cm H2O ± 2.2 cm H2O compared with 6.5 cm H2O ± 2.4 cm H2O in the CCATT group (p = 0.002). CONCLUSIONS: Lung injury in the combat theater severe enough to exceed the capability of CCATT transport is uncommon. Patients for whom ALRT was activated had significantly higher positive end expiratory pressure and FIO2 than those transported by CCATT. One-fourth of patients for whom ALRT was considered died before the team could be launched; transport may have been a futile consideration in these patients. Patients with even severe acute respiratory distress syndrome can be successfully transported by experienced, equipped specialty teams.",
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T2 - Development and utilization of the acute lung rescue team

AU - Dorlac, Gina R.

AU - Fang, Raymond

AU - Pruitt, Valerie M.

AU - Marco, Peter A.

AU - Stewart, Heidi M.

AU - Barnes, Stephen L.

AU - Dorlac, Warren C.

PY - 2009/4/1

Y1 - 2009/4/1

N2 - BACKGROUND: Critical Care Air Transport Teams (CCATTs) are an integral component of modern casualty care, allowing early transport of critically ill and injured patients. Aeromedical evacuation of patients with significant pulmonary impairment is sometimes beyond the scope of CCATT because of limitations of the transport ventilator and potential for further respiratory deterioration in flight. The Acute Lung Rescue Team (ALRT) was developed to facilitate transport of these patients out of the combat theater. METHODS: The United States TRANSCOM Regulation and Command/Control Evacuation System and the United States Army Institute of Surgical Research Joint Theater Trauma Registry databases were reviewed for all critical patients transported out of theater between November 2005 and March 2007. Patient demographics, diagnosis, and clinical history were abstracted and ALRT patients were compared with CCATT patients. RESULTS: The ALRT was activated for 11 patients during the study period. Five patients were transported as a result of these activations. Trauma-related diagnoses were responsible for 82% of these requests. ALRT missions comprised 0.6% of all critical patient movements out of the combat theater and 1% of ventilator transports. Average FIO2 was 0.92 ± 0.11 for ALRT patients and 0.53 ± 0.14 for CCATT patients (p = 0.005). ALRT patients required a mean positive end expiratory pressure of 19.0 cm H2O ± 2.2 cm H2O compared with 6.5 cm H2O ± 2.4 cm H2O in the CCATT group (p = 0.002). CONCLUSIONS: Lung injury in the combat theater severe enough to exceed the capability of CCATT transport is uncommon. Patients for whom ALRT was activated had significantly higher positive end expiratory pressure and FIO2 than those transported by CCATT. One-fourth of patients for whom ALRT was considered died before the team could be launched; transport may have been a futile consideration in these patients. Patients with even severe acute respiratory distress syndrome can be successfully transported by experienced, equipped specialty teams.

AB - BACKGROUND: Critical Care Air Transport Teams (CCATTs) are an integral component of modern casualty care, allowing early transport of critically ill and injured patients. Aeromedical evacuation of patients with significant pulmonary impairment is sometimes beyond the scope of CCATT because of limitations of the transport ventilator and potential for further respiratory deterioration in flight. The Acute Lung Rescue Team (ALRT) was developed to facilitate transport of these patients out of the combat theater. METHODS: The United States TRANSCOM Regulation and Command/Control Evacuation System and the United States Army Institute of Surgical Research Joint Theater Trauma Registry databases were reviewed for all critical patients transported out of theater between November 2005 and March 2007. Patient demographics, diagnosis, and clinical history were abstracted and ALRT patients were compared with CCATT patients. RESULTS: The ALRT was activated for 11 patients during the study period. Five patients were transported as a result of these activations. Trauma-related diagnoses were responsible for 82% of these requests. ALRT missions comprised 0.6% of all critical patient movements out of the combat theater and 1% of ventilator transports. Average FIO2 was 0.92 ± 0.11 for ALRT patients and 0.53 ± 0.14 for CCATT patients (p = 0.005). ALRT patients required a mean positive end expiratory pressure of 19.0 cm H2O ± 2.2 cm H2O compared with 6.5 cm H2O ± 2.4 cm H2O in the CCATT group (p = 0.002). CONCLUSIONS: Lung injury in the combat theater severe enough to exceed the capability of CCATT transport is uncommon. Patients for whom ALRT was activated had significantly higher positive end expiratory pressure and FIO2 than those transported by CCATT. One-fourth of patients for whom ALRT was considered died before the team could be launched; transport may have been a futile consideration in these patients. Patients with even severe acute respiratory distress syndrome can be successfully transported by experienced, equipped specialty teams.

KW - Acute lung injury

KW - Acute lung rescue team

KW - Aeromedical transport

KW - CCATT

KW - Military medicine

KW - Novalung

KW - War and patient transfer

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