Impact of Hemodynamic Events at Altitude on Outcomes for Critically Ill Patients
Abstract
Focus Area: This proposal addresses the FY21 JPC-6/CCCRP ERCA Focus Area of Patient movement – improved understanding of factors influencing clinical outcomes during air transport. This focus area relates to a persistent gap regarding the impact of air transport on clinical outcomes for combat wounded. This proposal addresses a fundamental challenge for research in closing this gap related to data limitations from in-flight medical records. Specifically, the project aims to leverage electronic data transfer capabilities to supplement current practices of handwritten documentation used for En Route Care (ERC) research. Research Description and Clinical Application: We propose to download vital sign data directly from patient monitors used during air transport missions. These monitors record vital signs multiple times per minute, but these data are not collected in usual clinical or research practice. Usual research practice is to abstract these data from written records, which typically record vital signs at hourly intervals. This proposed work would close that gap by collecting this data by two methods: a fee for service contract for Zoll Case Review services and data download through Battlefield Assisted Trauma Distributed Observation Kit (BATDOK), a military medicine documentation tool. These data would be combined with clinical characteristics and clinical outcomes collected from CCATT medical records and trauma databases in order to evaluate the impact of in-flight events on patient outcomes. The initial application of these data would define the problem of ERC in-flight vital sign abnormalities in terms of frequency and duration. We suspect that prior research has underestimated the prevalence of these events due to the current practice of hourly collection of vital signs. Next, these data would inform clinical and operational decisions such as instituting cabin altitude restriction (CAR). Specifically, a greater understanding of which patient populations are at greater risk of hypoxia may enable more targeted prescription of CAR treatment. Ultimately, this project bolsters future ERC research capabilities by leveraging current patient monitoring technology to enable high frequency data collection of in-flight events. Patient privacy risks due to research data collection will be mitigated with strict adherence to data security measures. Projected Timeline: We propose a 36-month period of performance for this work, including a 24-month period of data collection. Knowledge products at the conclusion of this period could immediately inform clinical practice guidelines (CPGs) related to CAR, medical documentation practices, and in-flight management of combat wounded to improve patient outcomes. Future projects could use the innovative processes developed in this proposal to evaluate non-invasive hemoglobin (SpHb) measurement devices in flight and create a more robust quality improvement (QI) network to provide feedback to ERC teams regarding whether CPG hemodynamic treatment goals were met in flight. Target Patient Population: The target patient population for this proposal is combat wounded requiring air transport. While the study population are critically ill combat wounded, improved understanding of the impact of altitude on in-flight vital sign abnormalities could improve care of combat wounded undergoing either fixed-wing or rotary wing evacuations after injury. This project would improve the care of this population by measuring the impact of in-flight clinical management on vital sign abnormalities during flight and the impact of these events on patient outcomes. Ultimately, these knowledge products would be incorporated into CPGs to reduce morbidity and mortality from in-flight vital sign abnormalities during ERC.
Document Details
- Document Type
- DoD Grant Award
- Publication Date
- Dec 28, 2022
- Source ID
- W81XWH2211107
Entities
People
- William T Davis
Organizations
- Henry M. Jackson Foundation for the Advancement of Military Medicine
- United States Army