Descriptive analysis of COVID-19 aeromedical evacuations by Critical Care Air Transport Teams

Davis, Maj William T.; Ng, Maj Patrick C.; Cutright, Julie E.; Savell, Shelia C.; Arana, Allyson A.; McCarvel, Brooks; Maddry, Lt Col Joseph K.

Background: Preserving aeromedical evacuation capabilities for critically ill patients with COVID-19 required innovation for en route care logistics, training, and equipment. The aim of this study was to describe characteristics and in-flight interventions for patients with suspected COVID-19 requiring aeromedical evacuation by U.S. Air Force Critical Care Air Transport Teams (CCATT). Methods: We performed a retrospective chart review of patients with suspected COVID-19 requiring aeromedical evacuation by CCATT from April 2020 to February 2021. We included patients with an available CCATT medical record and transport with COVID-19 infection isolation precautions. CCATT medical records were the data source, and we performed descriptive analyses of patient characteristics and in-flight interventions. Results: We reviewed 460 records and identified 16 patients for inclusion. The Transport Isolation System (50%) and Negatively Pressurized Conex (31%) were commonly utilized portable biocontainment units. Median patient age was 48.5 years and 94% were male. All patients required oxygen supplementation, with eight (50%) receiving mechanical ventilation. In-flight interventions among intubated patients (n=8) included vasopressors (50%), paralytics (25%), and patient-ventilator asynchrony management (63%). Conclusion: Patients with COVID-19 requiring CCATT transport were older than prior military en route care cohorts, and in-flight interventions for patient-ventilator asynchrony were commonly required during mechanical ventilation.