Helicopter Emergency Medical Service Lifeliner 3 and 5, Nijmegen, The Netherlands.
Department of Anesthesiology, Pain and Palliative Medicine, Radboud University Medical Centre, Geert Grooteplein Zuid 10, Huispost 717, Route 714, Postbus 9101, 6500 HB, Nijmegen, The Netherlands.
Respir Res. 2022 Sep 19;23(1):256. doi: 10.1186/s12931-022-02177-5.
During the COVID-19 pandemic in The Netherlands, critically ill ventilated COVID-19 patients were transferred not only between hospitals by ambulance but also by the Helicopter Emergency Medical Service (HEMS). To date, little is known about the physiological impact of helicopter transport on critically ill patients and COVID-19 patients in particular. This study was conducted to explore the impact of inter-hospital helicopter transfer on vital signs of mechanically ventilated patients with severe COVID-19, with special focus on take-off, midflight, and landing.
All ventilated critically ill COVID-19 patients who were transported between April 2020 and June 2021 by the Dutch 'Lifeliner 5' HEMS team and who were fully monitored, including noninvasive cardiac output, were included in this study. Three 10-min timeframes (take-off, midflight and landing) were defined for analysis. Continuous data on the vital parameters heart rate, peripheral oxygen saturation, arterial blood pressure, end-tidal CO and noninvasive cardiac output using electrical cardiometry were collected and stored at 1-min intervals. Data were analyzed for differences over time within the timeframes using one-way analysis of variance. Significant differences were checked for clinical relevance.
Ninety-eight patients were included in the analysis. During take-off, an increase was noticed in cardiac output (from 6.7 to 8.2 L min; P < 0.0001), which was determined by a decrease in systemic vascular resistance (from 1071 to 739 dyne·s·cm, P < 0.0001) accompanied by an increase in stroke volume (from 88.8 to 113.7 mL, P < 0.0001). Other parameters were unchanged during take-off and mid-flight. During landing, cardiac output and stroke volume slightly decreased (from 8.0 to 6.8 L min, P < 0.0001 and from 110.1 to 84.4 mL, P < 0.0001, respectively), and total systemic vascular resistance increased (P < 0.0001). Though statistically significant, the found changes were small and not clinically relevant to the medical status of the patients as judged by the attending physicians.
Interhospital helicopter transfer of ventilated intensive care patients with COVID-19 can be performed safely and does not result in clinically relevant changes in vital signs.
在荷兰 COVID-19 大流行期间，危重症 COVID-19 患者不仅通过救护车在医院之间转移，还通过直升机紧急医疗服务（HEMS）转移。迄今为止，人们对直升机运输对危重症患者的生理影响知之甚少，尤其是 COVID-19 患者。本研究旨在探讨院内间直升机转运对机械通气严重 COVID-19 患者生命体征的影响，特别关注起飞、飞行中和降落期间。
纳入 2020 年 4 月至 2021 年 6 月期间由荷兰“Lifeliner 5”HEMS 团队转运的、并进行全面监测（包括无创心输出量）的所有通气危重症 COVID-19 患者。分析定义了 3 个 10 分钟时间窗（起飞、飞行中和降落）。连续收集心率、外周血氧饱和度、动脉血压、呼气末 CO 和使用电心电抗的无创心输出量等生命参数数据，并以 1 分钟间隔存储。使用单向方差分析分析时间窗内的时间变化，检查差异是否具有统计学意义。
98 例患者纳入分析。起飞期间心输出量增加（从 6.7 增加至 8.2 L/min；P<0.0001），这是由全身血管阻力降低（从 1071 下降至 739 达因·s·cm，P<0.0001）伴每搏量增加（从 88.8 增加至 113.7 mL，P<0.0001）所致。起飞和飞行中期其他参数无变化。降落期间心输出量和每搏量略有下降（从 8.0 降至 6.8 L/min，P<0.0001 和从 110.1 降至 84.4 mL，P<0.0001），总全身血管阻力增加（P<0.0001）。尽管有统计学意义，但根据主治医生的判断，这些发现的变化很小，与患者的医疗状况无临床相关。
对 COVID-19 通气重症监护患者进行院间直升机转运是安全的，不会导致生命体征出现有临床意义的变化。
