Down to the Wire? Ventilation during Intubated Stretcher Helicopter Winching

Abstract

The stretcher winching of intubated patients into a helicopter is an uncommon procedure. Positive pressure ventilation is required, which can be performed either manually with a self-inflating bag or automatically using a mechanical ventilator. The optimal method of ventilation has not been studied. Automatic ventilation has theoretical advantages in maintaining better oxygenation and stable arterial carbon dioxide levels, with less risk of airway disconnection. There is also likely to be better performance and situational awareness of the stretcher attendant during the winch, contributing to crew and patient safety. However, the ability to diagnose and manage airway disconnections and ventilator failure is of concern. To compare automatic vs manual ventilation during intubated stretcher helicopter winching. There were 2 phases to the trial. An initial static winch with a hoisting simulator was performed with 10 stretcher attendants, followed by a live helicopter winch at 30 feet into a Bell 412 with 5 attendants. Each attendant performed 2 separate winches with an intubated mannequin. During one winch the mannequin was ventilated with manual (bag) ventilation; an automatic ventilator was used for the other. Airway pressures were measured. The results showed no failure of automatic ventilation. Automatic ventilation was superior to manual ventilation. Automatic ventilation allowed for better situational awareness and perceived performance in winching maneuvers. There was one airway disconnection during a manual ventilation winch into the aircraft. Automatic ventilation is superior in providing stable, reliable, uninterrupted ventilation during simulated helicopter winching. The risk of ventilator failure and disconnection is low. Medical retrieval organizations should develop standard operating procedures, equipment, and training to facilitate automatic ventilation during helicopter winching.