• Joseph K Maddry, Allyson A Araña, Lauren K Reeves, Alejandra G Mora, Xandria E Gutierrez, Crystal A Perez, Patrick C Ng, Sean A Griffiths, and Vikhyat S Bebarta.
• United States Air Force En route Care Research Center/59th MDW/ST, San Antonio, TX.
• Mil Med. 2020 Sep 18; 185 (9-10): e1646-e1653.

IntroductionTraumatic brain injuries (TBIs) are life-threatening, and air transport of patients with TBI requires additional considerations. To mitigate the risks of complications associated with altitude, some patients fly with a cabin altitude restriction (CAR) to limit the altitude at which an aircraft's cabin is maintained. The goal of this study was to examine the effects of CARs on patients with TBI transported out of theater via Critical Care Air Transport Teams.Materials And MethodsWe conducted a retrospective chart review of patients with moderate-to-severe TBI evacuated out of combat theater to Landstuhl Regional Medical Center via Critical Care Air Transport Teams. We collected demographics, flight and injury information, procedures, oxygenation, and outcomes (discharge disposition and hospital/ICU/ventilator days). We categorized patients as having a CAR if they had a documented CAR or maximum cabin altitude of 5,000 feet or lower in their Critical Care Air Transport Teams record. We calculated descriptive statistics and constructed regression models to evaluate the association between CAR and clinical outcomes.ResultsWe reviewed the charts of 435 patients, 31% of which had a documented CAR. Nineteen percent of the sample had a PaO2 lower than 80 mm Hg, and 3% of patients experienced a SpO2 lower than 93% while in flight. When comparing preflight and in-flight events, we found that the percentage of patients who had a SpO2 of 93% or lower increased for the No CAR group, whereas the CAR group did not experience a significant change. However, flying without a CAR was not associated with discharge disposition, mortality, or hospital/ICU/ventilator days. Further, having a CAR was not associated with these outcomes after adjusting for additional flights, injury severity, injury type, or preflight head surgery.ConclusionsPatients with TBI who flew with a CAR did not differ in clinical outcomes from those without a CAR.Published by Oxford University Press on behalf of the Association of Military Surgeons of the United States 2020.

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