Hemodynamic events during en route critical care for patients with traumatic brain injury

William T. Davis, Kimberly L. Medellin, Julie E. Cutright, Allyson A. Arana, Richard Strilka, Derek Sorensen, Joseph K. Maddry, Shelia C. Savell, Patrick C. Ng

Research output: Contribution to journalArticlepeer-review

1 Scopus citations


BACKGROUND Exposure to stressors of flight may increase risk of secondary insults among critically injured combat casualties wounded with traumatic brain injury (TBI). The primary objective of this study was to describe the prevalence of hemodynamic events by phase of transport among patients with TBI transported by Critical Care Air Transport Teams (CCATT). METHODS We performed a secondary analysis of a retrospective cohort of 477 adults with moderate to severe TBI, who required transport by CCATT to Germany from multiple hospitals in the Middle East between January 2007 and May 2014. We abstracted clinical data from handwritten CCATT medical records. Hemodynamic events included systolic blood pressure <100 mm Hg and cerebral perfusion pressure <60 mm Hg. We calculated the proportion of patients experiencing hemodynamic events for each phase of flight. RESULTS We analyzed 404 subjects after exclusions for catastrophic brain injury (n = 39) and missing timestamps (n = 34). Subjects had high Injury Severity Scores (median, 29; interquartile range [IQR], 21-35) and a median flight time of 423 minutes (IQR, 392.5-442.5 minutes). The median of documented in-flight vital signs was 8 measurements (IQR, 6.5-8 measurements). Documented systolic blood pressure in-flight events occurred in 3% of subjects during ascent, 7.9% during early flight, 7.7% during late flight, and 2.2% during descent, with an overall in-flight prevalence of 13.9%. Among patients with intracranial pressure monitoring (n = 120), documented cerebral perfusion pressure events occurred in 5% of subjects during ascent, 23% during early flight, 17% during late flight, and 5.8% during descent, with an overall in-flight prevalence of 30.8%. CONCLUSION Documented hemodynamic events occurred during each phase of flight in severely injured combat casualties wounded with TBI, and episodic documentation likely underestimated the actual in-flight frequency of secondary insults. LEVEL OF EVIDENCE Prognostic and epidemiological; Level IV.

Original languageEnglish (US)
Pages (from-to)S41-S48
JournalJournal of Trauma and Acute Care Surgery
Issue number2
StatePublished - Aug 1 2022
Externally publishedYes


  • Brain injury
  • air transport
  • cerebral perfusion
  • combat casualties
  • en route care

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine
  • Surgery


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