Safety and Risk in Airway Management During Bariatric Air Medical Retrieval.

Area of Science:

• Emergency Medicine
• Critical Care Transport
• Anesthesiology

Background:

• Bariatric patients present unique challenges in critical care and transport due to their anatomy and physiology.
• Air medical services, like LifeFlight Retrieval Medicine in Australia, handle numerous retrievals annually across various platforms.

Purpose of the Study:

• To quantify and describe adverse events during air medical retrieval of bariatric patients.
• To identify risk factors and thresholds associated with adverse events in bariatric patient transport.

Main Methods:

• Retrospective analysis of bariatric patient retrievals from an electronic patient database (July 2019 - December 2021).
• Identification and quantification of adverse events, particularly airway adverse events (AAEs), during transport.
• Statistical analysis to compare bariatric and non-bariatric patient outcomes and identify weight-based risk thresholds.

Main Results:

• Bariatric patients (≥ 120 kg) were more likely to be male and require critical care interventions.
• A 1.5% absolute increase in high-interest events was observed in bariatric retrievals, with a 1.9-fold increased relative risk.
• Significantly higher rates of AAEs (49.2% vs. 30.0%) and postintubation desaturation (26% vs. 12%) in bariatric patients.
• A weight threshold of 105 kg optimally predicted AAEs, with increased odds for weights between 105-119 kg and ≥ 120 kg.

Conclusions:

• Air medical retrieval of bariatric patients is generally safe, despite an elevated risk of adverse events.
• Adverse event risk increases with patient weight, particularly concerning airway management.
• Implementing strategies to optimize emergency anesthesia is crucial for enhancing the safety of intubation in bariatric patients during retrieval.