Air Medical Journal最新文献

In June 2024, leaders in aviation medicine from across the United States, Canada, and Europe met for the sixth Leonardo Helicopters/Association of Critical Care Transport: The Path to High Reliability Futures of Aviation Medicine Symposium in Miami, FL. The symposia, now held every few years, grew from the 2003 Air Medical Leadership Congress: Setting the Healthcare Agenda for the Air Medical Community. The meetings’ goal is to gather leaders to distill, debate, and synthesize the state of the science while identifying, refining, and outlining conditions facilitating favorable evolution in civilian aviation medicine. Structured as thematic panel presentations followed by interactive all-attendee roundtable discussions, the gatherings build and expand an international network of thought leaders and proven doers. Meeting attendees have a common goal—accelerating learning and practice among early and developed systems moving toward a shared worldwide agenda for the future of aviation transport medicine.

Objective

Push-dose vasopressors are commonly administered to attenuate peri-intubation hypotension. The aim of this study was to describe the current use of push-dose vasopressors in critical care transport.

Methods

This was a retrospective chart review of adult patients (≥ 18 years) intubated between January 2017 and May 2023 who received push-dose vasopressors. The outcomes were incidence of push-dose vasopressor administration and the frequency of initiation or an increase in continuous vasopressor infusion.

Results

Of the 334 patients intubated during this period, 49 (14.7%) received push-dose vasopressors in the peri-intubation period. The mean preintubation shock index was 1.1 ± 0.5. Of those who received push-dose vasopressors, 34 (69.4%) received multiple push doses; the mean number of administrations was 2.5 ± 1.9. Most patients had persistent or recurrent hypotension (n = 39, 79.6%). Fifteen (30.6%) were started on a continuous vasopressor infusion, and 3 (11.1%) had an increase in an existing infusion postintubation.

Conclusion

Although push-dose vasopressors are convenient and appropriate in many settings, they inadequately address hypotension in critically ill patients with underlying shock. Further investigation is required to better elucidate the role of peri-intubation push-dose and continuous vasopressors in the critical care transport setting.

Objective

Advanced airway management (AAM) is a critical component of prehospital critical care. Airway management in flight can be more challenging because of spatial, ergonomic, and environmental factors. This study examines the frequency of in-flight intubation (IFI), first-pass success (FPS) rates, and definitive airway sans hypoxia/hypotension on first attempt (DASH-1A) across different locations of airway management.

Methods

We conducted a retrospective database analysis of all patients transported between January 2016 and July 2021 who received AAM from a single air medical service. Patient records were reviewed for location of intubation, patient characteristics, and FPS and DASH-1A rates. The primary outcome was the frequency of IFI. The secondary outcomes included FPS and DASH-1A rates by location and type of transport asset.

Results

During the study period, 473 patients required AAM. Three percent (15/473) of patients were intubated in an in-flight setting, 28% (130/473) were intubated on scene, and 70% (328/473) were intubated in a health care facility. The primary reason for IFI was unanticipated cardiac arrest or clinical deterioration. The overall FPS rate was 69% (328/473), and the DASH-1A rate was 49% (194/399). Based on the location of AAM, the FPS and DASH-1A rates were the lowest for on-scene intubations (56% [74/130] and 27% [20/74], respectively). Most of the on-scene AAM took place with rotor wing flight crews.

Conclusion

Airway management occurs infrequently in an in-flight setting and is necessary because of patient deterioration or cardiac arrest. Based on our results, we identified opportunities for targeted AAM quality improvement and clinical governance.

Objectives

One of the challenges in the implementation of point-of-care ultrasound in air medical transport is establishing a minimum proficiency standard and subsequently ensuring that all clinicians meet this standard. It is also challenging to objectively measure the effectiveness of hands-on ultrasound training. The aim of this study was to evaluate the level of proficiency among all clinicians in the program, measure the effectiveness of hands-on training, and to assess the feasibility of establishing and enforcing a minimum proficiency standard for all clinicians.

Methods

116 flight clinicians, all previously trained in point-of-care ultrasound, participated in a training session in which they were tasked with acquiring six diagnostic ultrasound views on live models. At the beginning of the session, their performance was evaluated by a trained observer and scored. Each view was given a score of 3 points if obtained proficiently with no guidance (minimum proficiency standard), 2 points if obtained with only slight prompting, and 1 point if obtained with significant guidance from the observer. The clinicians then participated in a guided training session and those who did not previously receive a perfect score of all threes, were reevaluated and scored again. Each clinician also completed a survey before and after the session in which they rated their confidence with their ability to obtain each view.

Results

The average score during the initial evaluation was 2.66 with 32 of the 116 clinicians (28%) obtaining a perfect score. The average score for those who were reevaluated at the conclusion of the training was 2.91 with 55 additional clinicians obtaining a perfect score. In the initial evaluation, 14 clinicians required significant guidance with one or more views. In the reevaluation this number fell to one. At the conclusion of the training, 75% of the clinicians were able to obtain all six diagnostic views with the desired minimum proficiency. In the initial confidence survey, when averaged across the six views, 1% of clinicians rated their confidence level as not at all, 5% as slightly, 20% as somewhat, 45% as fairly, and 28 % as completely. In the follow-up survey the results were 0% not at all, 0% slightly, 4% somewhat, 25% fairly, and 71% completely.

Conclusions

The baseline proficiency level in obtaining the diagnostic ultrasound views approved by our program was less than desirable. However, given the fact that a single training session resulted in the increase in number of clinicians who met the minimum standard from 28% to 75%, it is feasible to achieve a 100% compliance with this standard with additional training. Future research will focus on the amount and frequency of use and training required to maintain this proficiency once achieved. Another component of minimum proficiency not discussed here is the accuracy of interpretation of the d