Collective aeromedical transport of COVID-19 critically ill patients in Europe: A retrospective study

Abstract

Background: In early 2020, the coronavirus disease 2019 (COVID-19) pandemic outbreak has posed the risk of critical care resources overload in every affected country. Collective interhospital transport of critically ill COVID-19 patients as a way to mitigate the localised pressure from overloaded intensive care units at a national or international level has not been reported yet. The aim of this study was to provide descriptive data about the first six collective aeromedical evacuation (MEDEVAC) of COVID-19 patients performed within Europe.

Methods: This retrospective study included all adult patients transported by the first six collective MEDEVAC missions for COVID-19 patients performed within Europe on the 18^th, 21^st, 24^th, 27^th, 31^st of March and the 3^rd of April 2020.

Results: Thirty-six patients with acute respiratory distress syndrome (ARDS) were transported aboard six MEDEVAC missions. The median duration of mechanical ventilation in ICU before transportation was 4 days (3-5.25). The median PaO₂/FiO₂ ratio obtained before, during the flight and at day 1 after the transport was 180 mmHg (156-202,5), 143 mmHg (118,75-184,75) and 174 mmHg (129,5-205,5), respectively, with no significant difference. The median norepinephrine infusion rate observed before, during the flight and at day 1 after the transport was 0,08 µg/kg^-1. min^-1 (0,00-0,20), 0,08 (0,00-0,25), and 0,07 (0,03-0,18), respectively, with no significant difference. No life-threatening event was reported.

Conclusion: Collective aero-MEDEVAC of COVID-19 critically ill patients could provide a reliable solution to help control the burden of the disease at a national or international level.

Keywords: Acute respiratory distress syndrome; Aeromedical evacuation; COVID-19; Interhospital transport; Mechanical ventilation.

Fig. 1

Intensive Care Module of the MoRPHEE system (Crédit photo: Ministère des Armées).

Fig. 2

Pre, per and post transport evolution of PaO2/FiO2 ration and norepinephrine infusion rate. Panel A shows box plots for PaO2/FiO2 ratio (mmHg) measured successively in the referring intensive care unit on the day before transport (Before transport), during the aeromedical transport after a stabilisation period of 10 min after the take-off (During transport), and at day 1 after transport in the receiving unit (After transport). Boxes show median and quartiles, whiskers show 5^th and 95^th percentiles, dots are outliers. Panel B shows box plots for norepinephrine infusion rate (µg.kg-1.min-1) measured successively in the referring intensive care unit on the day before transport (Before transport), during the aeromedical transport after a stabilisation period of 10 min after the take-off (During transport), and at day 1 after transport in the receiving unit (After transport). Boxes show median and quartiles, whiskers show 5^th and 95^th percentiles, dots are outliers.