En Route Resuscitation – Utilization of CCATT to Transport and Stabilize Critically Injured and Unstable Casualties

• Published in: Military medicine 2019-05, Vol.184 (5-6), p.e172-e176
• Main Authors: Maddry, Joseph K, Ball, Eric M, Cox, Daniel B, Flarity, Kathleen M, Bebarta, Vikhyat S
• Format: Article
• Language: English
• Subjects: Adult; Afghan Campaign 2001; Air Ambulances - statistics & numerical data; Aircraft; Blast Injuries - complications; Blast Injuries - epidemiology; Blast Injuries - therapy; Casualties; Critical Care - methods; Critical Illness - epidemiology; Critical Illness - therapy; Emergency Medical Services - methods; Emergency Medical Services - standards; Emergency Medical Services - statistics & numerical data; Humans; Iraq War, 2003-2011; Male; Patient Transfer - methods; Patient Transfer - statistics & numerical data; Patients; Resuscitation - methods; Resuscitation - statistics & numerical data; United States - epidemiology
• ISSN: 0026-4075; 1930-613X
• DOI: 10.1093/milmed/usy371

Abstract Introduction The U.S. Air Force utilizes specialized Critical Care Air Transport Teams (CCATT) for transporting “stabilized” patients. Given the drawdown of military forces from various areas of operation, recent CCATT operations have increasingly involved the evacuation of unstable and incompletely resuscitated patients from far forward, austere locations. This brief report describes unique cases representative of the evolving CCATT mission and provides future direction for changes in doctrine and educational requirements in preparation for en route combat casualty care. Methods and Materials This case series describes three patients who required significant resuscitation during CCATT transport from austere locations between April and November 2017. Approval for this project was received from the US Air Force 59th Medical Wing Institutional Review Board as non-research. Results Case 1: CCATT was dispatched to transport patient 1 who was reported to have a head injury after a fall. Upon evaluation of the patient onboard the aircraft, it was discovered that the patient was in cardiac arrest. Cardiopulmonary resuscitation was performed during tactical takeoff with frequent combat maneuvers. The patient developed a palpable pulse after three rounds of CPR, three doses of epinephrine, and one unit of packed red blood cells. Point of care laboratory analysis demonstrated a profoundly elevated lactate level. Cyanide poisoning was a concern but there was no antidote available in the available equipment set. After delivery to a medical facility, blood samples were positive for cyanide. Over the next 2 weeks, the patient improved and was discharged home, neurologically intact. Case 2: Patient 2 sustained complex blast injuries and bilateral lower extremity amputations. He required early transport for continuous renal replacement therapy (CRRT). The patient received 200 units of blood products in the 24 hours prior to transport and developed renal failure, pulmonary edema, and elevated ICP. During the 7 hour flight, Patient 2 received frequent adjustments of vasopressor medications, multiple Dakins solution soaks and flushes, and 1 unit of fresh frozen plasma. He remained alive 2 months later. Case 3: The team was notified to collect an urgent patient with a blast lung injury and bilateral lower extremity amputations. The ground team encountered difficulty ventilating the patient. Patient 3 arrived in the back of a pickup truck accompanied by medics and bei