PURPOSE: Evaluate the safety of flying adults on extracorporeal life support at cabin pressures of 6500 to 8000 feet. The standard of care used by experienced neonatal extracorporeal transport teams is a cabin pressure of 5000 feet, which balances flight time, turbulence and fuel consumption against the gas expansion and hypoxia of high altitude.
METHODS: Review of three long range adult extracorporeal transports over distances of 3181, 3213, and 4052 miles at cabin pressures of 6500 to 8000 feet. One pumpless and two veno-venous extracorporeal support devices were used. Two patients suffered from gunshot wounds that required pneumonectomy and one patient suffered from an unknown infection. Endpoints included evaluation of neurologic status, oxygen requirements, oxygen saturation, partial pressures of oxygen, and blood flow rates before, during, and after flight.
RESULTS: The Glasgow Coma Scales were 15, 15 and 11t (tracheostomy mouthing words appropriately) within three weeks of transport. The oxygen requirement in flight increased 10, 5, and 7 percent. Oxygen saturation via pulse oximetry remained stable in one patient and fluctuated by 2-6% in the other two. The partial pressure of oxygen in the patients’ arterial blood varied by 4-6mmHg. Blood flow rates varied slightly on takeoff and landing but remained stable at 1.5 (pumpless support), 3.8, and 4.0 liters per minute. Ventilatory pressures and volumes were reduced for the patient on pumpless support and not changed for the patients on veno-venous extracorporeal support. Chest tubes for both trauma patients were clamped on the pneumonectomy side and placed to suction on the other side. There were no significant complications in flight.
CONCLUSIONS: Transport of adults receiving extracorporeal support may be done safely at cabin pressures of 6500 to 8000 feet.
CLINICAL IMPLICATIONS: An extracorporeal circuit appears to attenuate the deleterious effects of altitude on pulmonary physiology. For respiratory failure recalcitrant to conventional treatment, air transport on extracorporeal support may be easier and more secure than transport requiring advanced or rescue modes of mechanical ventilation.
DISCLOSURE: The following authors have nothing to disclose: Erik Osborn, Melissa Tyree, Clayne Benson, Melody Kilcommons, Kristin Costales, Sandra Wanek, Warren Dorlac, Raymond Fang, Patrick Allan
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