Transit care of the ventilated critically ill in commercial airliners

Air ambulances and customized military aircraft are established modes of transporting critically ill patients. Defence services and aid agencies even have flying hospitals, replete with operating theatres and ICUs. With burgeoning travel by an increasingly elderly population, a growing number of travelling Australians suffer critical illnesses overseas. Transcontinental air ambulances are prohibitively expensive and many American and European commercial airlines ban travel by seriously ill patients.

Transit intensive care on board commercial airline flights poses complex physiological and logistic challenges. We have transported hundreds of critically ill patients and report on 10 episodes of aero-intensive care with IPPV on board scheduled passenger services. These were from the Philippines, the USA, the United Kingdom, Thailand, France, Norway and Austria on Qantas, Singapore Airlines, Thai Airways and Malaysia Airlines.

The aviation environment imposes a bewildering array of electronic, safety and security related issues to be overcome. The entire mobile ICU weighs 100 kg. A vacuum-mattress on a stretcher fitted to the cabin floor at the rear of the economy-class cabin and screened off from the other passengers ensures patient privacy (Fig. 1). Oxygen is scarce and extremely expensive during flight. We employed the 'circle system' with a CO₂ absorber and in-line oxygen analyser. Mobile suction, infusion pumps, transit-care monitors and portable blood gas analysers were all adapted for use in commercial aircraft.

Figure 1

(abstract P65)

Australia and New Zealand lead the world in transit care of the critically ill in commercial airliners.