A race against time: transatlantic transfer of a critically ill infant
In the high-stakes world of paediatric critical care, some cases test the limits of medical expertise and logistics. This is the story of a seven-month-old infant’s journey from Israel to Cincinnati Children’s Hospital
Born prematurely at 34 weeks via emergency C-section due to premature rupture of membranes and breech presentation, our patient’s 2,650-gram start was just the beginning of his struggles. Diagnosed with small bowel atresia, he underwent three major surgeries in his first seven months.
The latest emergency procedure revealed a double volvulus of the small intestine, necessitating a 92-centimetre bowel resection. A subsequent exploration showed extensive necrosis, leading to a partial jejunum resection and an open abdomen post-laparotomy.
The call for specialised care
With the infant’s condition critical – intubated, ventilated, and requiring continuous sedation and paralysis – the decision was made to transfer him to Cincinnati Children’s Hospital. Enter MedAssis, known for managing complex cases including ventilated.
The journey begins
The team, consisting of a Paediatric Critical Care Unit (PICU) Physician, PICU Nurse, and a Critical Care Paramedic, created a flying intensive care unit (ICU). As they assumed care in Israel, the gravity of the situation was palpable. The commercial flight to New York marked the first leg of this critical journey.
Throughout the flight, the team closely monitored vital signs. Heart rate fluctuated between 100–112bpm, while blood pressure remained low but stable around 75/40mmHg. Oxygen saturation was maintained at 100% with 2L/min supplemental oxygen. Ventilator settings were carefully adjusted, maintaining a respiratory rate of 25 breaths/min with a pressure control of 15cmH2O.
Regular i-STAT analyses showed a pH of 7.47, pCO2 of 36mmHg, and bicarbonate of 26mmol/L, indicating mild metabolic alkalosis. Electrolytes, particularly potassium at 3.6mmol/L, were closely monitored.
The final stretch
In New York, the seamless transfer from commercial aircraft to private air ambulance showcased MedAssis’s expertise. The final leg to Cincinnati saw continued critical care, with urine output closely monitored at 3.8–4ml/kg/ hour, indicating adequate perfusion despite low blood pressure.
MedAssis has upheld strong relationships with leading commercial airlines, creating the trust needed to approve medical flights (MEDIF) seamlessly.
Reflection on safety and complexity
As the infant was safely admitted to Cincinnati Children’s Hospital PICU, Paediatric Critical Care Doctor Dr Amir Zilkha reflected on MedAssis’s commitment to patient safety. “Each mission, no matter how complex, undergoes rigorous approval. Our Medical Director, [Dr Ami Mayo], an active ICU head in a leading Israeli hospital, personally reviews each case, with additional approval from our operational manager.”
This multi-layer process allows MedAssis to undertake the most challenging cases, including ventilated patients, on both air ambulances and commercial aircraft for transatlantic missions. “We’re often dealing with lifeand-death situations,” Dr Zilkha noted. “Our ability to safely transport these critically ill patients can be the difference between survival and loss.”
The final leg to Cincinnati
saw continued critical
care, with urine output
closely monitored
The successful execution of these complex medical cases is a testament to the exceptional skills and dedication of our front-line medical team. Our physicians, each a seasoned expert in their field, work in tandem with paramedics and nurses who possess years of hands-on experience in intensive care unit settings. This collaborative approach ensures that our patients receive the highest quality care, even in the most challenging circumstances.