Ventilation during helicopter stretcher winching of intubated patients
Hunter Retrieval Service, Newcastle, Australia
Anaesthetist and retrieval consultant in Hunter New England Local Health District.
The winching of intubated patients into a helicopter is rare. Intermittent positive pressure ventilation is mandatory, which can either be performed manually with a self-inflating bag, or automatically using a portable ventilator. The optimal method of ventilation has not been formally investigated, though personal and institutional opinion abounds.
Automatic ventilation would theoretically provide improved oxygenation, more stable arterial carbon dioxide levels and possibly a reduced risk of airway disconnection. Safety could be improved by allowing higher situational awareness, contributing to crew and patient safety. However ventilator failure, and the diagnosis and management of such, is of concern.
We performed a simulation trial by winching an intubated manikin and monitoring airway pressures, comparing manual to automatic ventilation.
Automatic ventilation did not fail, whilst manual ventilation displayed significant pauses, inconsistent rates and both high and low airway pressures, with one disconnection. Automatic ventilation permitted better situational awareness and performance in winching manoeuvres.
Discussion of the 'intubated stretcher winch' will include literature review, logistics, decision making, medical care, equipment, monitoring, pharmacology, training and human factors.