Air Medical Journal最新文献

Objective

The purpose of this scoping review was to identify and characterize helicopter emergency medical services (HEMS) outcomes literature from 2023, with the goal of describing updates to the Critical Care Transport Collaborative Outcomes Research Effort HEMS Outcomes Assessment Research Database (HOARD).

Methods

Using Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guidelines, a multireviewer approach was used to source and review articles published or in preprint databases from 2023. The articles included assessed a patient-centered outcome for HEMS versus a non-HEMS control group. Article characteristics included the journal impact factor (JIF), diagnostic group (trauma or nontrauma), and geographic origin. Categoric analyses comparing 2023 studies with HOARD studies from the previous decade (2013-2022) were executed with the Fisher exact test; nonnormal JIF data were described using median and interquartile range and analyzed (vs 2013-2022) with rank sum testing.

Results

Of the initial records (N = 4,486), 4,410 were screened out, leaving 76 for full-text review. Of these, 58 were discarded, and 18 were classified as eligible for addition to HOARD. Most studies (14/18, 78%) focused on trauma, and an equally high proportion (14/18, 78%) came from North America. The median JIF was 2.4 (interquartile range, 1.2-3.6). Compared with HOARD studies from the previous decade, 2023 studies were similar with respect to diagnostic focus (P = .779), geographic origin (P = .171), and JIF (P = .531).

Conclusion

This scoping review provides information on 18 HEMS outcomes studies new to the evidence base in 2023.

In the acute setting, subglottic stenosis poses a unique airway management challenge, particularly when presenting to a facility where subspecialty care is not available. We present a case of idiopathic subglottic stenosis with acute respiratory distress managed at a community hospital to highlight the challenges of diagnosis, initial airway management, and mechanical ventilation of this rare but life-threatening condition.

Objective

Patients who undergo interhospital transfer, particularly for intensive care unit (ICU) care, experience greater length of stay and mortality. There is evidence that patients transferred for surgical ICU care experience higher mortality rates; however, differences in length of stay or mortality across other ICU types remain unclear. The goals of this work were to assess how length of stay and mortality differ by ICU subspecialties.

Methods

We conducted a retrospective analysis of an existing critical care transfer data repository. We used multiple and logistic regression to identify significant factors that contribute to differences in length of stay and mortality for surgical ICU patients.

Results

There were no differences in length of stay or mortality based on ICU subspecialty. For every 1-year increase in age, mortality odds increased by 8.6% (P = .002). Patients transferred from an ICU had a longer length of stay by 6.3 days (P < .001). Non-Caucasian patients had a shorter length of stay by 3.4 days (P = .012).

Conclusion

Length of stay and mortality are not influenced by ICU subspecialty. Further research is needed to determine the mechanism by which sending unit type and race influence length of stay and identify other factors that predict mortality for SICU patients.

Acute airway obstruction, whether partial or complete, requires immediate intervention to prevent fatal outcomes. An 81-year-old man with a history of pneumonia experienced respiratory distress after attempting to swallow a large piece of meat. Despite attempts by his daughter, back blows and abdominal thrusts failed to dislodge the obstruction, and he collapsed, prompting an emergency call. Upon the arrival of the emergency medical team, the patient was conscious with good oxygen saturation but deteriorated during transport, becoming unresponsive and unable to cough. Upon assessment by the doctor helicopter team, the patient's condition was critical with low oxygen saturation and unstable vital signs. Using a laryngoscope, the team identified a large meat fragment near the vocal cords and successfully removed it, relieving the obstruction. The patient's respiratory distress improved, and he was transported to the hospital without the need for intubation. Further examination at the hospital revealed sinus tachycardia and lung abnormalities on a computed tomography scan but no significant abnormalities in blood tests. The patient was admitted for observation and received antibiotics for prophylaxis. He recovered well, with no further need for oxygen by the second day and was discharged on the fourth day, highlighting the importance of prompt intervention in airway emergencies.

Malaysia has a 34.3 million population, with 40% residing in rural areas. Since gaining independence, the Malaysian government put a tremendous focus as well as resources in improving the health care services with the aim of improving the health status of Malaysians. The Ministry of Health is the main stakeholder in ensuring quality of services, accessibility, and equity in providing health care to the community. Unfortunately, some rural areas in the state of Sarawak are beyond reachable via land or water transportation. Hence, a flying doctor service was introduced in the state of Sarawak in 1973 for this purpose. However, the quality of care is still limited because of various reasons and challenges faced. Nevertheless, efforts in improving the health care status of the rural continue as we aim to leave no one behind.

The use of bedside ultrasound imaging has become a valuable tool in emergency medicine, and its use in the transport environment is increasing. Survival Flight, the critical care transportation program at University of Michigan/Michigan Medicine, began to train flight nurses in its use beginning in 2014. Nurses were trained during mandatory training sessions, with different skills and interpretations gradually added. Nurses who have been trained in procedures such as pericardiocentesis are empowered to use that training to perform procedures via online or, if necessary, offline medical direction. The Butterfly IQ+ devices are currently utilized. Pericardiocentesis can be a lifesaving procedure for pericardial tamponade. However, its use in relieving tamponade caused by thoracic aortic dissection remains controversial due to the possibility of worsening the dissection with restoration of more normal blood pressure. We report 2 cases of in-transport, ultrasound-guided pericardiocentesis for 2 patients with tamponade caused by type A aortic dissection and discuss its use in this clinical situation.

Objective

Since 2018, Thailand's helicopter emergency medical service (HEMS) has been used to transport critically ill pediatric patients from Tak Province's community hospitals to the tertiary care hospital. This article describes a pilot study to look at the feasibility of comparing mortality rates and complications during transport.

Methods

This retrospective pilot study used data from the medical records of the referring and receiving hospitals. Participants were critically ill patients under 18 years of age who were transferred between facilities using HEMS or ground emergency medical services (GEMS) between January 2018 and December 2022. HEMS transported 9 patients, whereas GEMS transported 52.

Results

The predominant age group was newborns. Respiratory-related conditions were the most common diagnoses. The majority of patients underwent intubation and displayed abnormal respiratory rates and levels of consciousness before flight. Approximately one third were hypotensive or required vasoactive drugs. Cardiac arrest requiring cardiopulmonary resuscitation was the most common significant complication during transport in the HEMS group (22.2%). Meanwhile, changing hospital destination because of an unstable patient condition was the most common complication during transport in the GEMS group (3.9%). Hypotension was the most common complication upon arrival at the receiving hospital in both groups (25% versus 8%). HEMS demonstrated shorter transport times.

Conclusion

HEMS reduced transport times compared with GEMS. However, there was a higher incidence of cardiac arrest requiring cardiopulmonary resuscitation during transfer and hypotension upon arrival.