Impact of Medical Evacuation From Mayotte to La Réunion on Intracranial Pressure in Pediatric Patients

Q3 Nursing

Air Medical Journal Pub Date : 2026-07-01 Epub Date: 2026-03-23 DOI:10.1016/j.amj.2026.02.014

Lukas Widmann MD, Yvonnick Boue MD, Vincent Gilles MD, Julien Carvelli MD, Perrine Venot MD

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引用次数: 0

Abstract

Objective

Long-distance medical evacuation by ground, maritime, and fixed-wing air transport (EVASAN) from Mayotte to La Réunion is frequent for pediatric neurocritical patients. The impact of EVASAN on intracranial pressure (ICP) control is poorly documented, especially in this geographic and socioeconomic context. We aimed to analyze ICP variations during EVASAN and to describe associated physiological parameters and short-term outcomes.

Methods

Retrospective cohort study of pediatric patients (< 18 lt; 18 years) evacuated from Mayotte to La Réunion between January 2019 and December 2024 with invasive ICP monitoring at departure (n = 22). ICP values and clinical variables (mean arterial pressure [MAP], heart rate [HR], oxygen saturation [SpO₂], end-tidal carbon dioxide [EtCO₂], fraction of inspired oxygen [FiO₂], temperature, sedation, and vasopressor use) were extracted at predefined time points: initial (baseline), departure (intensive care unit), ferry transfer, takeoff, during flight, landing, and arrival at La Réunion pediatric intensive care unit. Primary outcome was ICP variation during EVASAN. Wilcoxon signed-rank tests compared paired time points; Spearman correlations explored associations. The study was approved under MR-004; consent was obtained as described.

Results

A total of 22 patients (mean age 9.4 years, 73% pediatric traumatic brain injury) were included. The ferry phase was associated with a modest but statistically significant median increase in ICP (+ 5 mm Hg, P = .038). No sustained increase between departure and arrival was observed (median + 3 mm Hg, P = .251). FiO₂ increased from a median of 0.3 to 0.4 (P = .008), whereas SpO₂, MAP, HR, and EtCO₂ remained stable. There was no correlation between ICP variation and 6-month Pediatric Glasgow Outcome Scale scores. Missing data and heterogeneity of care restricted inference.

Conclusion

In this single-center retrospective series, EVASAN was associated with transient ICP increases during the maritime ferry phase but not with sustained intracranial hypertension at arrival nor worse mid-term neurological outcome.

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马约特到拉拉西乌医疗后送对儿科患者颅内压的影响。

目的：从马约特岛（Mayotte）到拉拉西乌恩（La r union）的儿童神经危重症患者经常采用陆运、海运和固定翼航空运输（EVASAN）进行长距离医疗后送。EVASAN对颅内压（ICP）控制的影响文献很少，特别是在这个地理和社会经济背景下。我们的目的是分析EVASAN期间的ICP变化，并描述相关的生理参数和短期结果。方法：回顾性队列研究2019年1月至2024年12月期间从马约特（Mayotte）撤离到拉雷姆union的儿科患者（< 18岁；18岁），在出发时进行有创ICP监测（n = 22）。在预定的时间点提取ICP值和临床变量（平均动脉压[MAP]、心率[HR]、血氧饱和度[SpO2]、潮末二氧化碳[EtCO2]、吸入氧分数[FiO2]、体温、镇静和血管加压剂的使用）：初始（基线）、出发（重症监护室）、渡轮转移、起飞、飞行中、降落和到达La r union儿科重症监护室。主要结局是EVASAN期间的ICP变化。Wilcoxon符号秩检验比较成对时间点；斯皮尔曼相关性探讨了关联。该研究在MR-004下获得批准；如所述获得同意。结果：共纳入22例患者，平均年龄9.4岁，73%为儿童外伤性脑损伤。轮渡期与ICP中位数增加（+ 5 mm Hg, P = 0.038）相关，但有统计学意义。在出发和到达之间没有观察到持续的增加（中位数+ 3 mm Hg， P = 0.251）。FiO2从0.3增加到0.4 (P = 0.008)，而SpO2、MAP、HR和EtCO2保持稳定。ICP变化与6个月儿童格拉斯哥结局量表评分之间没有相关性。数据缺失和护理异质性限制了推断。结论：在这个单中心回顾性研究中，EVASAN与海运期间短暂的颅内压升高有关，但与抵达时持续的颅内高压无关，也与中期神经预后更差无关。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Air Medical Journal Nursing-Emergency Nursing

CiteScore

1.20

自引率

0.00%

发文量

112

审稿时长

69 days

期刊介绍： Air Medical Journal is the official journal of the five leading air medical transport associations in the United States. AMJ is the premier provider of information for the medical transport industry, addressing the unique concerns of medical transport physicians, nurses, pilots, paramedics, emergency medical technicians, communication specialists, and program administrators. The journal contains practical how-to articles, debates on controversial industry issues, legislative updates, case studies, and peer-reviewed original research articles covering all aspects of the medical transport profession.