Fixed-wing air transport of patients with spinal pathologies: a scoping review of current evidence and future research priorities

BACKGROUND: Rapid transportation of neurosurgical patients, particularly those with acute spinal trauma, is critical due to the direct association between total prehospital time and mortality. While existing aeromedical guidelines focus primarily on helicopter (rotor-wing) transport, there is limited evidence consolidating the effects of fixed-wing aircraft transport, which exposes patients to unique physiological stressors due to higher operational altitudes. METHODS: Using a recognised framework for scoping reviews, a European-based research team conducted biweekly discussions to ensure a comprehensive approach. This scoping review utilized a four-phase framework: identification, screening, data extraction, and contextualisation. A systematic literature search via OVID databases up to September 19, 2024, and manual searches of 15 journals identified studies involving fixed-wing aircraft transport for spinal pathology patients, excluding helicopter or animal studies. Additionally, a panel of experts in neurosurgery and aviation reflected on their experiences and transferable lessons. RESULTS: 12 studies were included, covering 105 spinal injury cases and 1 spinal tuberculosis case. Key physiological factors unique to fixed-wing transport include reduced atmospheric pressure, low humidity, extended transport duration, smoother acceleration/deceleration, and better medical accessibility compared to rotor-wing transport. Recommendations from the literature and expert experiences emphasise respiratory stability, humidification, oxygen supplementation, pressure injury prevention, bowel/bladder management, airway cuff pressure management, and venous thromboembolism prophylaxis. CONCLUSION: There is an urgent need for evidence-based recommendations tailored to fixed-wing transportation of spinal pathology patients, emphasizing altitude-induced physiological changes to optimize patient safety. Further targeted research is essential to develop comprehensive clinical protocols.