Patients with Traumatic Brain Injury Transported by Critical Care Air Transport Teams: The Influence of Altitude and Oxygenation During Transport
Abstract
Introduction: Traumatic brain injuries (TBIs) are life threatening, and air transport of patients with TBI requires additional considerations. To mitigate the risks of complications associated with altitude, some patients fly with a cabin altitude restriction (CAR) to limit the altitude at which an aircraft's cabin is maintained. The goal of this study was to examine the effects of CARs on patients with TBI transported out of theater via Critical Care Air Transport Teams (CCATTs). Materials and Methods: We conducted a retrospective chart review of patients with moderate-to-severe TBI evacuated out of combat theater to Landstuhl Regional Medical Center (LRMC) via CCATT. We collected demographics, flight and injury information, procedures, oxygenation, and outcomes (discharge disposition and hospital/ICU/ventilator days). We categorized patients as having a CAR if they had a documented CAR or maximum cabin altitude of 5,000 feet or lower in their CCATT record. We calculated descriptive statistics and constructed regression models to evaluate the association between CAR and clinical outcomes. Results: We reviewed the charts of 435 patients, 31% of which had a documented CAR. Nineteen percent of the sample had a PaO2 lower than 80 mm Hg, and 3% of patients experienced a SpO2 lower than 93% while in-flight. When comparing preflight and inflight events, we found that the percentage of patients who had a SpO2 of 93% or lower increased for the No CAR group, whereas the CAR group did not experience a significant change. However, flying without a CAR was not associated with discharge disposition, mortality, or hospital/ICU/ventilator days. Further, having a CAR was not associated with these outcomes after adjusting for additional flights, injury severity, injury type, or preflight head surgery. Conclusions: Patients with TBI who flew with a CAR did not differ in clinical outcomes from those without a CAR.
Document Details
- Document Type
- Technical Report
- Publication Date
- Dec 30, 2020
- Accession Number
- AD1131294
Entities
People
- Alejandra G. Mora
- Allyson A. Araña
- Crystal A. Perez
- Joseph K Maddry
- Lauren K. Reeves
- Patrick C. Ng
- Sean A. Griffiths
- Vikhyat S Bebarta
- Xandria E. Gutierrez
Organizations
- 59th Medical Wing