Page 66 - 2022 Spring JSOM

Expeditionary Mechanical Ventilation in Conjunction

With Extracorporeal Life Support During Ground Transport

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Brendan M. Beely, BS, RRT *; George Harea, BS ; Daniel S. Wendorff, BS ;
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Jae Hyek Choi, PhD, DVSc ; Kyle Sieck, BS ; Vitali Karaliou, MD ;
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Jeremy W. Cannon, MD ; James H. Lantry III, MD ; Leopoldo C. Cancio, MD ;
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Valerie G. Sams, MD ; Andriy I. Batchinsky, MD 11
ABSTRACT
Background: We assessed the use of an FDA-cleared transport were rudimentary, with limited capabilities that would be
ventilator with limited functions and settings during ground insufficient to support the most injured, those requiring full
transport in a swine model of ground evacuation. We hypoth- respiratory support. Our laboratory recently tested the next
esized that when used as an adjunct to extracorporeal life iteration of one of these ventilators—the SAVe II—as the ven-
support (ECLS), the device would enable safe mobile venti- tilator during transport in a porcine model of polytrauma and
latory support during ground evacuation. Methods: Female ground evacuation. The SAVe II was assessed as an adjunctive
Yorkshire swine (n = 11; mean, 52.4 ± 1.3 kg) were sedated ventilation tool in an expeditionary environment in conjunc-
and anesthetized and received mechanical ventilation (MV) tion with other mobile critical care equipment, including con-
with a standard intensive care unit (ICU) ventilator and were tinuous venovenous ECLS. ECLS has been put forward by the
transitioned to the Simplified Automated Ventilator II (SAVe U.S. Army Medical Research and Development Command as
II; AutoMedx) during ground transport. MV served as an one of the most promising future technologies to care for the
adjunct to ECLS in all animals. Ventilator performance was most severely injured. We hypothesized that when used as an
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assessed in the uninjured state on day 1 and after bilateral adjunct to ECLS, the SAVe II is reliable and enables safe mo-
pulmonary contusion on day 2. Data were collected pre- and bile ventilatory support during ground evacuation.
post-transport on both days. Results: During 33 transports,
the SAVe II provided similar ventilation support as the ICU
ventilator. Mean total transport time was 38.8 ± 2.1 minutes. Methods
The peak inspiratory pressure (PIP) limit was the only variable This study was approved by our local Institutional Animal
to show consistent differences pre- and post-transport and be- Care and Use Committee and was carried out in compliance
tween ventilators. No adverse events occurred. Conclusion: As with the Animal Welfare Act, the principles of the Guide for
an adjunctive supportive device during ground transport, the the Care and Use of Laboratory Animals, and all local, state,
SAVe II performed adequately without failure or degradation and federal guidelines for ethical use of animals. Secondary
in subject status. Further testing is warranted to elucidate the level approval was provided by the office of the Surgeon Gen-
clinical limits of this device during standalone use. eral of the Air Force.

Keywords: acute respiratory distress syndrome; trauma; extra- Experimental Procedures
corporeal life support; mechanical ventilation; expeditionary Details of the experimental procedures used have been pre-
ground evacuation viously reported. The data reported here represent a con-
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venience sample of the larger study. Briefly, female Yorkshire
pigs (n = 11; mean, 52.4 ± 1.3 kg) were sedated and anesthe-
tized and received arterial and venous catheters, tracheostomy,
Introduction
and urinary catheter placement. All animals were started on
Large-scale combat operations and multidomain operations of volume-control ventilation with a full-function ICU ventilator
the future may result in both substantially higher casualty num- (Dräger V500; Dräger Medical) at 21% fraction of inspired
bers and an inability to rapidly evacuate these casualties, neces- oxygen (Fio ); positive end-expiratory pressure (PEEP), 5 cm
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sitating prolonged field care in place. The latter is of particular H O; tidal volume (V ), 10mL/kg; and respiratory rate (RR)
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importance for combat casualty care because forward-deployed titrated to maintain normocarbia (arterial partial pressure of
medics are in need of compact, simplified capabilities for MV carbon dioxide [Paco ], 35–45mmHg).
to enable early interventions during critical states. 2 2
After baseline measurements, animals were cannulated, and
To answer this need, small form-factor ventilators have been continuous venovenous ECLS was initiated (Cardiohelp;
developed and fielded. The initial versions of these devices Maquet, Gettinge Group) via a 23-Fr dual-lumen catheter
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*Correspondence to bbeely@genevausa.org
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1 Brendan M. Beely, George Harea, Daniel S. Wendorff, Jae Hyek Choi, Kyle Sieck, and Vitali Karaliou are affiliated with the Autonomous
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Reanimation and Evacuation (AREVA) Research Program, San Antonio, TX, and with The Geneva Foundation, Tacoma, WA. Jeremy W.
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Cannon is affiliated with the Division of Traumatology, Surgical Critical Care and Emergency Surgery, Perelman School of Medicine at the Uni-
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versity of Pennsylvania, Philadelphia, PA. James H. Lantry III is affiliated with Inova Fairfax Hospital, Falls Church, VA. Leopoldo C. Cancio is
affiliated with the U.S. Army Institute of Surgical Research, JBSA Fort Sam Houston, TX. Valerie G. Sams is affiliated with Brooke Army Med-
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ical Center, JBSA Fort Sam Houston. Andriy I. Batchinsky is affiliated with the AREVA Research Program and with The Geneva Foundation.
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