The need for multiple vascular access or preemptive central venous catheterization in patients requiring planned interhospital helicopter transport: a flight doctor’s suggestion

Hemorrhagic shock can develop due to severe bleeding, such as after major trauma, postpartum or gastrointestinal bleeding. At least two peripheral intravenous routes with large-bore catheters are recommended to reverse hemorrhagic shock, and such functional intravenous routes are essential for the proper management of other concurrent diseases as well. Conditions during helicopter transportation are different from those seen in-hospital, and the primary concerns are to maintain aseptic conditions, protect patient’s privacy, and prevent infection risk, especially during pandemics, such as the ongoing COVID-19. Herein, I describe two recent experiences of improper management during helicopter transport due to intravenous line malfunction. Subsequently, based on my experience, I suggest the use of multiple intravenous routes or preemptive central catheterization in patients requiring helicopter transportation.

Successful use of extended cardiopulmonary resuscitation followed by extracorporeal oxygenation after venlafaxine-induced takotsubo cardiomyopathy and cardiac arrest: a case report

Background Severe venlafaxine intoxication may cause arrhythmias, cardiac failure, and even cardiac arrest. Case presentation A 48-year-old caucasian male with an extensive psychiatric history ingested a high dose of venlafaxine causing a serum venlafaxine concentration of 12.6 mg/L 24 hours after ingestion. Seven hours post-ingestion, he experienced tonic–clonic seizures, and 8 hours later, takotsubo cardiomyopathy was recognized followed by cardiac arrest. The patient was resuscitated with prolonged cardiopulmonary resuscitation including ongoing automatic external compressions during helicopter transportation to a tertiary hospital for extracorporeal membrane oxygenation treatment. Despite a cardiopulmonary resuscitation duration of 2 hours, 36 hours of extracorporeal membrane oxygenation, and a total of 30 days of intensive care, the patient made a full recovery. Conclusion In cases of intoxication-induced cardiac arrests among otherwise young and healthy patients, prolonged cardiopulmonary resuscitation and extracorporeal circulation can be a life-saving bridge to recovery.

P1739Does helicopter transport delay prehospital transfer for STEMI patients in rural areas? Findings from the CRAC France PCI registry

Background Whether helicopter transportation for ST-Elevation Myocardial Infarction (STEMI) patients in France is the faster alternative is not known. Data from United States and Europe are controversial and studies have been limited to small series of patients Purpose The aim of this study was to analyse delays in emergency medical system (EMS) transfer of STEMI patients from home to the nearest percutaneous coronary intervention (PCI) centre (primary transfer) or from non-PCI centres to PCI centres (secondary transfer) according to transport modalityin a rural French region. Methods and results Data from the prospective multicentre CRAC France PCI registrywere analysed for 1911 STEMI patients: 410 transferred by helicopter (HEMS) and 1501 by ground transport (GEMS). The primary endpoint was the percentage of transfers with first medical contact (FMC) to primary PCI (PPCI) within the 90-min recommended in guidelines. The secondary endpoint was time FMC–PPCI. With HEMS,FMC-PPCI <90 min was less frequently achieved than with GEMS (9.8% vs 37.2%; odds ratio 5.49; 95% confidence interval [3.90; 7.73]; p<0.0001). Differences were greatest for transfers <50 km (13.7% vs 44.7%; p<0.0001) and for primary transfers (22.4% vs 49.6%; p<0.0001). Median time from FMC to PPCI and from symptom onset to PPCI (total ischemic time) were significantly higher in HEMS group than in GEMS group (respectively 137 min vs 103 min; p<0.0001 and 261min vs 195 min; p<0,0001). There was no significant difference in in-hospital mortality between the HEMS and GEMS groups (6.9% vs 6.6%; p=0.88). STEMI patients FMC-PPCI < 90 min Conclusion Helicopter transport of STEMI patients was 5 times less effective than ground transport in maintaining the 90-min FMC-PPCI time recommended in guidelines, particularly for transfer distances <50 km. Acknowledgement/Funding Regional health agency of CVL, Medtronic, Boston Scientific, Abbot, Biosensor, Terumo, Biotronik, Lilly Daichii Sankyo, Hexacath and Braun.

An Evaluation of Sedatives for Use in Transport of Juvenile Endangered Fishes in Plastic Bags

Trucks and aircraft typically transport rare or endangered fishes in large unsealed tanks containing large volumes of water (typically hundreds of liters) during conservation efforts. However, to reduce weight and overall shipping costs, fish breeders commonly send ornamental fishes by mail in small sealed plastic bags filled with oxygen, minimal water, and a small amount of sedative. Our goal was to evaluate if we could also use these “minimal-water” methods used for shipping ornamental fishes to safely transport endangered Humpback Chub Gila cypha into remote locations within Grand Canyon on foot to eliminate helicopter transportation costs associated with conservation actions. In the laboratory, we placed 20 (mean = 193.9 g of fish/L, SD = 37.8) juvenile Bonytail Gila elegans or Humpback Chub in plastic bags containing 1 L of water and pure oxygen for 4, 8, and 12 h. Treatments contained either no sedative or one of three sedatives—AquaCalm (metomidate hydrochloride), Tricaine-S (tricaine methanesulfonate or MS-222), or Aqui-S 20E (eugenol)—to evaluate the effectiveness of minimal-water methods for use in fish transport. Aqui-S 20E and the control without sedatives exhibited the highest survival (logistic regression, Aqui-S 20E, p = 0.994, 95% CI [0.978, 0.998]; control, p = 0.995, 95% CI [0.981, 0.998]), followed by Tricaine-S (p = 0.933, 95% CI [0.902, 0.955]) and AquaCalm (p = 0.355, 95% CI [0.307, 0.406]). We also conducted a field trial in which we placed 240 juvenile Humpback Chub in shipping bags (n = 20 fish/bag/L of water; mean = 143.2 g of fish/L, SD = 9.72) with no sedative or 10.0 mg/L of Aqui-S 20E and transported them by vehicle and on foot. No fish perished during transport, indicating fisheries personnel can use these minimal-water methods to safely, and at little expense, transport endangered Humpback Chub into remote locations.