The Complexities of Aeronautical Transfer of Acutely Unwell Neurosurgical Patients

Anastasia Tasiou, Department of Neurosurgery, University Hospital of Larissa, Larissa, Greece. Electronic address: ttasiou@yahoo.com.
Christos Tzerefos, Department of Neurosurgery, University Hospital of Larissa, Larissa, Greece.
Maria Karagianni, Department of Neurosurgery, University Hospital of Larissa, Larissa, Greece.
Eleni Tsianaka, Department of Neurosurgery & Quality Department, Kuwait Hospital, Sabah Al Salem, Kuwait.
Mark Jarratt, Spinal Injuries Association, Health and Care Quality Team, Milton Keynes, United Kingdom.
Nurperi Gazioğlu, Department of Neurosurgery, Istinye University, Medical Faculty, Istanbul, Turkey.
Konstantinos Peramatzis, Department of Aviation Engineering, School of Aviation, Australian University, Safat, Kuwait.
Marike Ld Broekman, Department of Neurosurgery, Haaglanden Medical Center and Leiden University Medical Center, Leiden, the Netherlands.
Ana Rodríguez-Hernández, Department of Neurological Surgery, Germans Trias i Pujol University Hospital, Universidad Autónoma, Barcelona, Spain.
Daniela L. Ivan, Neurosurgery Department, Henri Mondor Hospital, AP-HP, Créteil, France.
Insa K. Janssen, Department of Neurosurgery, Hôpitaux Universitaires de Genève, Geneva, Switzerland.
Maria Karampouga, Department of Neurological Surgery, Center for Cranial Base Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA; Department of Neurosurgery, Nicosia General Hospital, Nicosia, Cyprus.
Xanthoula Lambrianou, Department of Neurosurgery, University Hospital of Larissa, Larissa, Greece.
Stiliana Mihaylova, Clinic of Neurosurgery, Sv. Ivan Rilski University Hospital, Medical University of Sofia, Sofia, Bulgaria.
Ayşegül Esen Aydin, Department of Neurosurgery, Arnavutkoy State Hospital, Istanbul, Turkey.
Silvia Hernandez-Duran, Klinik für Neurochirurgie, Universitätsmedizin Göttingen, Göttingen, Germany.
Niina Salokorpi, Department of Neurosurgery, Oulu University Hospital, Oulu, Finland and Research Unit of Clinical Neuroscience, Medical Research Center, Oulu University, Oulu, Finland.
Gail Rosseau, Department of Neurological Surgery, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA; Barrow Global, Barrow Neurological Institute, Phoenix, Arizona, USA.
Mary Murphy, Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, United Kingdom.

Document Type

Journal Article

Publication Date

2-8-2025

Journal

World neurosurgery

Volume

195

DOI

10.1016/j.wneu.2025.123692

Keywords

Aeromedical evacuation; Aeronautical transfer; Craniospinal pathologies; Equipment; Flight stressors; Logistics; Neurosurgery

Abstract

OBJECTIVE: Neurosurgical care is difficult to access in many scenarios. Aeromedical evacuation of acutely unwell neurosurgical patients from remote, isolated, or poorly equipped locations can be considered. This article aims to provide a framework of logistical factors that deserve special consideration in the preparation of these patients for transfer. METHODS: We searched all relevant medical literature, military reports, and travel industry documents on transfer of neurosurgical patients. This review was combined with a senior author's (M.J.) extensive relevant experience, to present important factors for neurosurgeons to consider during planning of aeromedical evacuation, highlighting potential preventable causes of deterioration en route. RESULTS: Several criteria must be met for a transfer to be considered. The safe transfer of patients with craniospinal pathology requires efficient collaboration between the referring teams, the receiving units/departments, and the medical transfer service. Clear communication, qualified personnel, and appropriate transportation equipment must be available for the transfer. One must consider unique stressors during the air transfer, including the risk of hypoxia on certain types of flights. Vibration, loud noise, acceleration, and changes in barometric pressure en route may negatively affect the patient during transfer. Patient stabilization before transfer is a priority. Medical conditions that can potentially worsen in-flight should be corrected before transfer. The use of a checklist before departure is highly recommended and is included herein. The timing of transfer concerning the postoperative patient deserves special consideration. CONCLUSIONS: Although there is little published information, this review provides useful criteria and parameters needed for safe aeromedical evacuation of neurosurgical patients.

Department

Neurological Surgery

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