Long-Distance Transport of Ventilated Patients: Advantages and Limitations of Air Medical Repatriation on Commercial Airlines

Abstract Introduction To illustrate the advantages and limitations of transporting ventilated intensive care unit patients over intercontinental distances on commercial airlines, this case series reports 8 ventilated patients repatriated by an air medical transport company. Patients Eight ventilated patients, 3 suffering from internal and 5 from neurologic diseases. Distances ranged from 1700 to 10280 nautical miles with transport times from 04:10 hours to 21:55 hours. For 3 patients, a dedicated patient transport compartment (PTC) in the aircraft cabin was used. All patients were ventilator-dependent for a minimum of 11 days before transport (48 days median, 113 days maximum). Results One patient went into cardiac arrest during the flight and died. None of the other patients experienced any emergency or invasive procedures, other than peripheral venous access necessary during the flight. In all patients, ventilation was adjusted with respect to the blood gas analysis at least once during the transport. No technical failures or drop-outs occurred during the flights. None of the flights had to be diverted for technical or medical reasons. Conclusion Long distance international transport of ventilated intensive care unit patients is an extremely cost intensive and logistically challenging task. In a certain subgroup of relatively stable ventilated patients, transport on commercial airlines offers advantages in terms of cost effectiveness and reduced transport time and acceleration/deceleration trauma as a result of multiple fuel stops.