Hypothermic Cardiac Arrest: A Case Report of an Unexpected Survivor Using Air Medical Transportation in Nepal.

This is a case of a 34-year-old man surviving hypothermic cardiac arrest with excellent neurologic recovery in Nepal. After 3 days without communication at an altitude of approximately 6,000 m, the patient was located in a crevasse and retrieved by a helicopter-supported search and rescue team. At first contact, he was reported to be breathing and shivering with appropriate pupillary response. The patient was then flown to a local teaching hospital where he was assessed on arrival and found to be in cardiac arrest with absence of spontaneous breathing and a central pulse and bilaterally fixed and dilated pupils. An electrocardiogram demonstrated asystole, and his core temperature was unrecordably low on the available device. After resuscitation and return of spontaneous circulation, the patient received a secondary helicopter transfer to a major hospital in the capital, Kathmandu, where his recovery continued. The report discusses the physiological basis of the relatively favorable outcomes observed in hypothermic cardiac arrest and highlights the operations and capability of helicopter emergency medical services in a country on the United Nations list of least developed nations.

Cardiopulmonary resuscitation in low-resource settings: a statement by the International Liaison Committee on Resuscitation, supported by the AFEM, EUSEM, IFEM, and IFRC.

Most recommendations on cardiopulmonary resuscitation were developed from the perspective of high-resource settings with the aim of applying them in these settings. These so-called international guidelines are often not applicable in low-resource settings. Organisations including the International Liaison Committee on Resuscitation (ILCOR) have not sufficiently addressed this problem. We formed a collaborative group of experts from various settings including low-income, middle-income, and high-income countries, and conducted a prospective, multiphase consensus process to formulate this ILCOR Task Force statement. We highlight the discrepancy between current cardiopulmonary resuscitation guidelines and their applicability in low-resource settings. Successful existing initiatives such as the Helping Babies Breathe programme and the WHO Emergency Care Systems Framework are acknowledged. The concept of the chainmail of survival as an adaptive approach towards a framework of resuscitation, the potential enablers of and barriers to this framework, and gaps in the knowledge are discussed, focusing on low-resource settings. Action points are proposed, which might be expanded into future recommendations and suggestions, addressing a large diversity of addressees from caregivers to stakeholders. This statement serves as a stepping-stone to developing a truly global approach to guide resuscitation care and science, including in health-care systems worldwide.

Endotracheal Intubation at 3,600 Meters Above Sea Level for High-Altitude Pulmonary Edema Followed by Helicopter Evacuation in Nepal.

Ranging from 64 to 8848 m above sea level, Nepal is a country rich in hilly and mountainous terrain.1 24.8% of Nepal's land area is above 3000 m, 18.9% is between 3000 and 5000 m, and 5.9% is above 5000 m.2 Hikers and trekkers are increasingly attracted to this challenging altitude and terrain, which presents risks for altitude sickness and other physical complications. Responding to medical emergencies in high-altitude areas in Nepal is highly challenging. This difficulty is often exacerbated by inclement weather, unavailability of helicopters, and poor communication regarding the location and condition of patients requiring medical attention and evacuation. High-altitude pulmonary edema (HAPE) is an illness characterized by non-cardiogenic pulmonary edema, which occurs not infrequently in individuals who rapidly ascend above 2500-3000 m in elevation,3 and which has a high mortality rate if not treated in a timely manner. Improved outcomes would be likely if skilled and equipped medical staff had better access to the sites of high-altitude expeditions in Nepal, so that life-saving interventions could be performed promptly. We report the case of a patient with HAPE who was intubated in the field at an altitude of 3600 m, and then evacuated via helicopter to a healthcare facility.

System of Helicopter Emergency Medical Services in Nepal: A Study at Nepal Mediciti Hospital.

OBJECTIVE: Nepalis have benefited from helicopter emergency medical services (HEMS) since 2013. Helicopters are coordinated from private companies for medical transport. There are no helicopters dedicated solely for emergency medical services. Private helicopter companies and hospitals collaborate to transfer patients. Mountainous terrain, traffic infrastructure problems, and distance to rural facilities designate HEMS as the preferred method for transferring patients in Nepal. This article discusses the 2 methods used to fly patients between facilities and from scene calls. The first and preferred method is when patients received medical support from trained personnel en route to the appropriate facility. This method allows for quicker access to a physician with appropriate care throughout a transfer. The second method used occurs when patients were flown with no medical team or trained care onboard the helicopter. Regardless of the method used, HEMS has proven to be beneficial because it limits out-of-hospital time, alleviates patient load from overwhelmed hospitals, and delivers patients to critical care facilities out of reach by ground emergency medical services. The aim of this study was to interpret the current system of helicopter emergency medical services in Nepal and to determine the difference in patient outcomes when transferred with care onboard and without. METHODS: This was a retrospective study of patients who were transferred by helicopter to Mediciti Hospital in Nepal from November 2017 to December 15, 2019. RESULTS: During the study, a total of 425 patients were transferred by helicopter. Two hundred forty-three (57.18%) patients were moved with the support of the medical team onboard. One hundred eighty-two (42.82%) were flown without medical support. Of the 243 patients, 173 (71.19%) were medical, and 70 (28.81%) had suffered traumatic injuries. From the 182 nonsupported patients, 115 (63.19%) were medical, and 67 (36.81%) were traumatic. One hundred eighty (74.07%) of the patients with medical support went to the intensive care unit (ICU). Forty-two (23.07%) without medical support went to the ICU. Ninety-one (50.55%) patients who received support went to the ICU and stayed for 1 to 5 days. Thirty-eight (90.48%) patients with no medical support en route stayed 1 to 5 days in the ICU. Of the 243 patients who received medical support en route, 69 died (28.4%) during the course of treatment in the hospital. Of the 182 who were flown without medical care during transport, 6 (3.33%) died. CONCLUSION: HEMS effectiveness and usefulness are rapidly growing in Nepal. Having trained medics onboard delivering care can be beneficial. When patients are critically ill, it is preferred to fly them via helicopter with a medical crew onboard.

Helicopter Emergency Medical Services During Coronavirus Disease 2019 in Nepal.

Virtually every country in the world has been affected by coronavirus disease 2019 (COVID-19). Nepal is a landlocked country located in Southern Asia. Nepal's population has suffered greatly due to a shortage of critical care facilities, resources, and trained personnel. For appropriate care, patients need access to hospitals mostly in the centrally located capital city of Kathmandu. Unfortunately, Nepal's resources and personnel dedicated to transferring COVID-19 patients are scarce. Road and traffic infrastructure problems and mountainous terrain prevent ground ambulances from performing effectively. This, in addition to Nepal lacking national standards for prehospital care, create great challenges for transferring patients via ground emergency medical services. The concept of helicopter emergency medical services (HEMS) began in 2013 in Nepal. Presently, 3 hospitals, Nepal Mediciti Hospital, Hospital for Advanced Medicine and Surgery (HAMS), and Grande International Hospital, coordinate with private helicopter companies to run proper HEMS. One entity, Simrik Air, has dedicated 2 Airbus H125/AS350 helicopters for the sole purpose of transferring COVID-19 patients. HEMS effectiveness is expanding in Nepal, but much remains to be accomplished.

An unusual case of myocardial noncompaction involving both ventricles--case report.

Noncompaction of ventricular myocardium (NCVM) is a rare congenital cardiomyopathy characterized by numerous excessively prominent trabeculations and intertrabecular recesses in the myocardium without any other cardiac structural abnormality. Transthoracic echocardiography is the imaging modality of choice for diagnosing NCVM. Although this disease commonly affects the left ventricle, the right ventricle or both ventricles can rarely be affected. We report the case of an 18-year-old male patient with NCVM involving both ventricles.