Dr Claire Bertenshaw1,2,3, Miss Renee Bolot1, Mr Paul Jarrett6, Dr Clinton Gibbs4, Dr Jacob O’Gorman1,3,5
1LifeFlight Retrieval Medicine, Brisbane, Australia, 2Queensland Ambulance Service, Brisbane, Australia, 3Royal Brisbane and Women’s Hospital, Brisbane, Australia, 4Retrieval Services Queensland, Townsville, Australia, 5Royal Flying Doctors Service, Brisbane, Australia, 6Queensland University of Technology, Brisbane, Australia
Objective
The aim of this retrospective case review is to determine the safety and efficacy of High Flow Nasal Cannula (HFNC) usage in the adult and paediatric population during rotary wing retrievals. There is sparsity of research in use of HFNC in retrieval-medicine, especially on helicopters.
Methods
All cases that were transferred via LifeFlight Queensland’s rotary wing assets between July 2019- January 2020 who received oxygen therapy via HFNC were included. Cases were identified by searching a pre-existing data base. Data collected included patient demographics, flight demographics, indication for HFNC and any recorded adverse events occurring while in the care of the retrieval team.
Results
Twenty eight patients met inclusion criteria; 19 adults and nine paediatric. Eight were less than two years and one nine-year-old whom was excluded from analysis as not physiologically comparable to either the adult or infant groups. The median age of the adult cohort was 64 years, with a flight time of 54 minutes. Indications for HFNC were acute respiratory failure (ARF), acute pulmonary oedema and acute respiratory distress. Eleven inflight deteriorations were captured including hypoxia, hypotension and arrhythmia. With one escalation in oxygen delivery to non-invasive ventilation.
Median infant age was eleven months with a flight time of 39mins. Indications for HFNC included; ARF and acute respiratory distress. Six children were diagnosed with bronchiolitis and two had pneumonia. Two in-flight deteriorations of hypoxia were captured requiring an increase in FiO2.
Deficiencies in medical record keeping were noted specifically; inflight oxygen calculation documentation.
Conclusion
This case review is unable to demonstrate significant relationships between HFNC and outcome measures due to small sample size, but lays the foundations for further research, creates interest and drives change. It also highlighted areas of deficiencies in documentation which will be addressed through further education in the application of HFNC.
Biography:
Claire is an Emergency Physician. She is a co-clinical lead at the LifeFlight Brisbane Base. She splits her time between the pre-hospital and hospital environment also working for Queensland Ambulance Service and the Royal Brisbane and Women’s Hospital Emergency and Trauma Centre. Her particular interests include the pre-hospital trauma care of sub-specialty patient groups and high functioning critical care teams.