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If a patient is seriously ill with Coronavirus, they often need additional help with breathing. Due to the illness, the patient’s lungs are not powerful enough to supply the body with sufficient oxygen on their own. To increase the oxygen supply, non-invasive procedures are preferred, during which the patient receives additional oxygen via a breathing mask. But if this is not enough, the patient needs to be intubated. But what exactly is intubation and how does it affect the medical repatriation of a Coronavirus patient?
How is intubation done?
Intubation involves inserting a tube into the patient's throat and trachea. The hollow tube is stable enough to keep the respiratory tract open and at the same time prevents foreign substances such as saliva from entering the lungs. A ventilator can now be connected to the outer end of the tube, which pumps oxygen into the lungs.
The patient is placed in an artificial coma while intubated. Accordingly, the patient is not aware of any aspect of the intubation. The respiratory muscles stop working because the oxygen supply is secured.
The advantage of intubation: larger amounts of oxygen can be pumped directly into the lungs for a longer period of time. Since the patient's oxygen supply is no longer dependent on his or her capacity to breathe, a steady supply is ensured. However, intubation also has disadvantages: it is an invasive procedure and therefore can be a strain on the body.
COVID-19 ambulance flights and intubation
If a Coronavirus patient needs to be transported in an ambulance aircraft, intubation is not an obstacle. The medical facilities on board enable the transport and continuous ventilation of intubated patients as long as they are otherwise fit to fly.
In fact, some patients who are able to manage with non-invasive ventilation in hospital need to be intubated for an ambulance flight. This process is explained in more detail here.
Why do some patients need to be intubated for ambulance flights?
A COVID-19 infection can weaken the lungs so much that under normal conditions on the ground artificial ventilation will already be necessary. Now we also need to add to this the fact that the air in an aircraft cabin is less oxygenated due to the altitude of the flight. This would require the weakened lungs to be supplied with even more oxygen, and this can no longer be guaranteed by using non-invasive methods after a certain point.
Since intubation is a relatively complex procedure, it should preferably not be performed during a flight – especially not in infectious Coronavirus patients. The facilities certainly exist to do this on board and, in an emergency, a patient can be intubated in an ambulance jet. But such emergency situations should be avoided at all costs. Therefore, it is not an option to ‘wait and see’ whether the non-invasive procedures may be sufficient.
When does a patient need to be intubated for the air ambulance flight?
Fortunately, intubation of the patient is only necessary if the Coronavirus infection is very severe. Unfortunately, there is no single value or indicator that a doctor can use to accurately assess the need for intubation. Rather, the overall health status of the patient must be taken into account when making the decision. However, it can be said that patients who need to be intubated for an ambulance flight are already ventilated with large amounts of oxygen in hospital before the flight takes place.
Alternatives to a COVID-19 medical repatriation with intubation?
The idea of intubation is often met with doubts and fears from the patient’s relatives and is often rejected – especially if it is to be carried out for the purpose of the ambulance flight and the patient is managing without it on the ground (i.e. in hospital) at that time. Without intubation, however, the patient cannot be declared fit to fly, so the ambulance flight cannot take place. Are there any alternatives in such situations? Unfortunately, all the other options are associated with significant disadvantages and are therefore rarely considered.
- Travelling in a ground ambulance saves the patient having to cope with the oxygen-depleted air in an aircraft. But it is associated with other problems. A long journey in an ambulance is much more stressful and exhausting for the patient and is thus ruled out in many cases for that reason alone. In addition, despite limited space on board, the ambulance must be able to carry enough oxygen for the duration of the journey – including a reserve so that the crew is prepared for unforeseen delays such as traffic jams. Accordingly, a patient transfer by ambulance is only feasible over very short distances.
- Ambulance helicopters do not fly as high as aeroplanes, so the air on board contains more oxygen. But a helicopter's range is considerably shorter, which means that a helicopter has to land more frequently to refuel. In addition, there is little space in a helicopter for additional oxygen bottles, so that this means of transport must almost always be discouraged.
- Waiting also has its disadvantages. Of course, the patient could initially stay in the hospital where treatment is taking place, in the hope that his or her condition would improve enough to be able to cope with an ambulance flight without intubation later on. However, the reason for the medical repatriation of a Coronavirus patient is usually dissatisfaction with the patient’s current medical treatment. Accordingly, the idea that a significant improvement in the patient's condition will occur in this situation seems unlikely. In addition, there is a risk that the Coronavirus infection will get worse and that the patient will no longer be able to travel, even with intubation.
The decision for or against intubation always lies with the patient and their relatives. Concerns and worries are perfectly understandable in this situation. However, we must also bear in mind that a competent doctor only advises intubation if the benefits outweigh the risks. Unfortunately, the desire for the medical repatriation of the Coronavirus patient may have to be weighed against the desire for exclusively non-invasive ventilation. In most cases, there is simply no realistic alternative to travelling in an ambulance aircraft.
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