• Iscander M Maissan, Leonie A Verbaan, Marco van den Berg, Robert Jan Houmes, Robert Jan Stolker, and Dennis den Hartog.
• Erasmus University Medical Center Rotterdam, Department of Anesthesiology, Rotterdam, The Netherlands. Electronic address: I.Maissan@erasmusmc.nl.
• Air Med. J. 2018 Jul 1; 37 (4): 249-252.

ObjectiveAfter severe (primary) brain injury, Dutch physician-based helicopter emergency medical services start therapy to lower the intracranial pressure (ICP) on scene to stop or delay secondary brain injury. In some cases, helicopter transportation to the nearest level 1 trauma center is indicated. During transportation, the head-down position may counteract the ICP-lowering strategies because of venous blood pooling in the head. To examine this theory, we measured the optic nerve sheath diameter (ONSD) during helicopter transport in healthy volunteers.MethodsThe ONSD was measured by ultrasound in healthy volunteers during helicopter liftoff and acceleration in the supine position or with a raised headrest.ResultsIn this proof-of-principle study, the ONSD increased during helicopter acceleration (-9° Trendelenburg, mean = 5.6 ± .3 mm) from baseline (0° supine position, mean = 5.0 ± .4 mm). After headrest elevation (20°-25°), the ONSD did not increase during helicopter acceleration (mean ONSD = 5.0 ± .5 mm).ConclusionONSD and ICP seem to increase during helicopter transportation in -9° head-down (Trendelenburg) position. By raising the headrest of the gurney before liftoff, these effects can be prevented.Copyright © 2018 Air Medical Journal Associates. Published by Elsevier Inc. All rights reserved.

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