CRITICAL CARE AIR TRANSPORT TEAM (CCATT) CAPABILITIES

Intubated U.S. military patients are routinely transported out of theater by the Critical Care Air Transport Team (CCATT).50–52 From October 2001 to May 2006, these made up 1,265 of 1,995 (63%) of all CCATT patients.53 The decision to transport a patient with ARDS should be made jointly with the theater CCATT Director and the validating flight surgeon, the on-site CCATT physician, and the Role 3 Chief of Trauma and/or ICU Director. Considerations should include the severity of the patient’s respiratory failure, the trajectory of that respiratory failure (improving or worsening), and the experience of the team.22

U.S. Air Force CCATT has both the Impact 731™ (Zoll Medical Corporation., Chelmford, MA) ventilator and the LTV 1000™ (CareFusion., Yorba Linda, California) ventilator for use in transport.54 The Impact 731 operates in volume control, pressure control, SIMV, and CPAP with and without pressure support. Up to 100% O2 can be applied as can PEEP of up to 25 cm H2O. Flow rates range from 0 to 100 L/min at 40 cm H2O. Peak inspiratory pressures range from 10 to 80 cm H2O. Inverse ratio ventilation is not possible with the Impact 731.

 

ADVANCED CRITICAL CARE EVACUATION TEAM (ACCET) CAPABILITIES

In 2012, SAMMC established an ECLS team and now offers long-range transport of patients with severe ARDS with or without ECLS. The team consists of a medical/pulmonary critical care physician, a surgical intensivist, an ICU nurse, and a respiratory therapist. Advanced therapies used by this team include high frequency percussive ventilator (Percussionaire VDR-4), inhaled prostacyclin (Flolan), and ECLS for the management of patients with moderate to severe ARDS who could not otherwise be safely transported.55–58

Indications for requesting an ACCET for transport to the U.S. include the following:

 

ACCET team members are specifically trained in the indications for and the use of these modalities which have all been appropriately vetted through the combat casualty care and transport communities.