Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Case Reports
. 2018 Sep;97(38):e12516.
doi: 10.1097/MD.0000000000012516.

Medical evacuation from abroad of critically ill patients: A case report and ethical issues

Jérôme Allyn  1 , Nathalie Coolen-Allou, Bénédicte de Parseval, Thomas Galas, Olivier Belmonte, Nicolas Allou, Guillaume Miltgen
Affiliations
Case Reports

Medical evacuation from abroad of critically ill patients: A case report and ethical issues

Jérôme Allyn et al. Medicine (Baltimore). 2018 Sep.

Abstract

Rationale: Patients repatriated from foreign hospitals are sources of extensively drug-resistant (XDR) bacteria outbreaks. Thus, an individual benefit potential for the patient opposes a collective ecological risk potential. These ethical issues have not been well studied.

Patient concerns: We report the case of a 74-year-old patient repatriated from Mauritius to the French island of Reunion who presented mesenteric infarction evolving over several days, and who suffered a cardiac arrest before transfer.

Diagnoses: In Reunion Island, a CT-scan revealed a multisegmental enlarged parietal enlargement associated with free peritoneal effusion and a suboccluded aspect of the superior mesenteric artery.

Interventions: Surgical exploration showed a severe mesenteric infarction with peritonitis, and a resection of 120cm of the small intestine was conducted. This patient was infected with a vanA glycopeptide-resistant Enterococcus faecium and a carbapenem-resistant Klebsiella pneumoniae which produced carbapenemases NDM-1 and OXA-181, which required specific care and could have led to a local epidemic.

Outcomes: The patient died after 9 days after being admitted to the ICU.

Lessons: Repatriation of critically ill patients from abroad should be considered according to ethical criteria, evaluating, if possible, the expected benefits, and ecological risks incurred. Limiting unnecessary transfers could be an effective measure to limit the spread of XDR bacteria.

PubMed Disclaimer

Conflict of interest statement

The authors have no conflicts of interest to disclose.

Figures

Figure 1
Figure 1
A, Computed tomography scan performed at intensive care unit admission showing a multisegmental enlarged parietal enlargement associated with free peritoneal effusion in the process of partitioning. B, Exploration of the abdominal cavity by laparotomy, showing a severe mesenteric infarction with peritonitis.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. Lepelletier D, Berthelot P, Lucet JC, et al. French recommendations for the prevention of “emerging extensively drug-resistant bacteria” (eXDR) cross-transmission. J Hosp Infect 2015;90:186–95. - PubMed
    1. Bennett RA. Ethics surrounding the medical evacuation of catastrophically injured individuals from an operational theatre of war. J R Army Med Corps 2016;162:321–3. - PubMed
    1. Beauchamp T, Childress J. Principles of Biomedical Ethics. 5th ed.New York: Oxford University Press; 2001.
    1. Thompson DR. Principles of ethics: in managing a critical care unit. Crit Care Med 2007;35:S2–10. - PubMed
    1. Nordmann P, Poirel L, Toleman MA, et al. Does broad-spectrum beta-lactam resistance due to NDM-1 herald the end of the antibiotic era for treatment of infections caused by Gram-negative bacteria? J Antimicrob Chemother 2011;66:689–92. - PubMed

Publication types

MeSH terms