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APRV in Kids: The Good, The Bad and The Ugly
Jennifer Flint, MD
Children's Mercy Hospital
This is a case-based discussion on how to use APRV in children. Cases include a near-drowning patient with ARDS and a patient with Glenn single ventricle physiology with bronchiolitis. This talk will discuss clinical indications for APRV during transport and how APRV works physiologically. Case-based presentations will guide the learner on how to transition from traditional modes of ventilation to APRV, how to pick initial settings, and how to titrate settings in addition to what hemodynamic and ventilator waveforms to monitor during the transition.
A brief overview of cardiopulmonary interactions using APRV as a ventilation strategy will also be discussed. This will include review of a paper describing the hemodynamic changes associated with APRV compared to conventional ventilation in pediatric patients with right ventricular dysfunction and/or Cavo pulmonary shunts such as the Glenn and Fontan circuit. This talk will also discuss some of the risk and difficulties with APRV, especially in younger patient populations.
Central VA-ECMO: What Could Possibly Go Wrong?
Brenda Kubiak, BSHA, FP-C, CES-A
Air Methods
This is a case study presentation of a male patient that presented to the ER with chest pain he was taken to the OR for a CABG. He went into cardiac arrest and was cannulated for central VA ECMO with an Impella device. Patient was in profound cardiogenic shock with vasoplegia on 2 mechanical circulatory devices. He was intubated, with multiple chest tubes and an open chest. Upon arrival to the OR, the team was packing his chest for the second time from multiple bleeding sites. He was profoundly hypotensive. This presentation will cover what was going on in the OR when the team arrived, what they did to treat and stabilize the patient and how they were able to successfully transport this patient by helicopter to the receiving CVICU.
Don't Forget About Me! Acute Right Ventricular Failure
Steve Bott, MD
AirMed, University of Utah
We all think about left ventricular failure when faced with a patient with cardiogenic shock, but right ventricular failure is often a co-existing or primary clinical problem, and the management is different, with little margin of error for treatment. Acutely increased RV afterload (pressure overload) or distention (volume overload) can rapidly progress to RV ischemia and failure, resulting in a lethal positive feedback loop.
We'll discuss why the RV can't take a joke (normal and pathologic physiology) common etiologies of acute RV failure, making the diagnosis, and rapid treatment options for the critical care transport environment. This will include treating the primary problem, evaluating and optimizing preload, options to minimize RV afterload, focusing on reducing pulmonary vascular resistance, increasing RV coronary perfusion to reduce ischemia, and finally options and considerations for inotropic support. We'll wrap up by presenting a couple of cases with initially unclear diagnosis, discuss common pitfalls, and then review optimal management strategies.
Paramedic Led Air Medical Transport of Conjoined Twins
Othman Basawil, AlphaStar Air Ambulance
Bader Al-Motariri, FPC-PNCCT, AlphaStar Air Ambulance
In this presentation, we will present a case study for the air medical transport of conjoined twins for the first time by certified and highly trained flight paramedics. This presentation will focus on the history of the patients, pre transportation management, transportation challenges, flight paramedic training, and required teamwork for a successful transfer. Neonatal air transport is complex, requiring specialized skills, advanced planning, and multidisciplinary coordination to ensure patient safety.
This real-life case study of transporting conjoined twins will detail the clinical conditions, transport logistics, and obstacles faced during the mission. This includes equipment modifications, space limitations, and in-flight medical care essential for neonatal transfers.
Additionally, we will highlight the training provided to flight paramedics, covering neonatal resuscitation, ventilator management, and handling critical conditions mid-flight. The session aims to share key lessons learned and best practices to improve the safety and efficiency of neonatal air medical transport, ensuring better outcomes for critically ill infants.
From Sound Waves to Clinical Saves: How Ultrasound Can Help Differentiate Your Dyspneic Patient in the Field and Change Your Management
Shaila Coffey, MD, FAEMS
UNMC
James R. Waller, BS, FP-C
Apollo MedFlight
Get ready to change the way you evaluate and manage your dyspneic patients in the field! POCUS is not just for trauma patients!
This session will delve into the use of prehospital POCUS in differentiating the cause and treatment of patients with shortness of breath. Cookie cutter management for COPD, pneumonia, asthma and CHF is a thing of the past. We will use case studies, real ultrasound video images, and discussion to help you parse out what is the cause of your patient’s shortness of breath and how you can better treat these patients as a prehospital clinician with POCUS.
Whether you use ultrasound every day within your service or you have never held a probe in your hand, you will walk away from this session being able to recognize B lines on a thoracic ultrasound and how that changes your management with patients you transport with shortness of breath.
Hypotension in the Neonate: They're NOT Just Little Adults
Chad Barber, MD
Cook Children's Medical Center
What is hypotension in a neonate and how do you treat it appropriately? Is this based purely on the mean blood pressure, or are there other factors to consider? When a baby is born and the cord is cut, many things change. As the cardiovascular system of a preterm neonate matures over time, the actual composition of a baby's cardiac structure changes, which impacts how babies respond to different pressors.
This session will review the physiological development of the preterm and term newborn's cardiovascular system, and attempt to define hypotension in the newborn. Then, we will explore various treatment options, including volume expanders and different pressors. Once you understand the physiology, the treatment options and how they work in both preterm and term neonates, you can make a more informed decision when choosing the best pressor for your patient, no matter their gestational age. You will become confident in managing hypotension in neonates, even if your treatment choices are limited while transporting our tiniest patients.
Swearingen's Top 5 Impossible Cases: A Year in Review
Charles Swearignen, BS, NRP, FP-C
University of Mississippi | MeduPros.com
Some patient cases stay with you—not just because they were difficult, but because they rewrote your approach to transport medicine. In this rapid-fire, case-based session, flight paramedic and 2025 Tim Hines Award recipient Charles Swearingen walks through his five most complex, high-acuity transports of the year. These aren’t textbook calls—they’re the impossible ones.
From a 4-day-old with sepsis to a 64-year-old patient with stroke, rhabdomyolysis, hyperkalemia, and atrial fibrillation with RVR—all at once—this lecture explores the chaos, the clinical pivots, and the team-based wins that made the difference. Each case is told through the lens of what was missed, what mattered, and what transport teams can learn to do better.
You’ll leave with pearls on sepsis, airway obstruction, status asthmaticus, vent management, hyperkalemia treatment, stroke care, and knowing when to push for a CT before activating lytics—because sometimes, it’s not the protocol that saves the patient. It’s the crew that questions it.
Tiny Baby, Big Problem: Neonatal Transport Strategies for The Smallest Patients
Courtney McLean, MD, MS
Children's Nebraska
In the United States, about 10.4% of all births are born premature. Ideally, preterm infants are transported before birth to a delivery hospital with appropriate NICU capabilities. However, premature babies can be born anywhere. The smaller the infant, the more complex and fragile the infant may be. The smallest of patients will require the smallest of equipment and specialized neonatal teams and incubators to stabilize and transport. In this session, we will review the risks, rates and outcomes of premature infants. This session will help educate why premature infants are at such high-risk during transport and what steps teams can take to be aware and prepared for the smallest of patients.
Learn skills, techniques and necessary supplies to help transport the smallest infants.
While The Perfusionist Sleeps: ECMO Essentials For Transport Teams
Michael Frakes, MS, APRN, FCCM, FAASTN, FAEN
Boston MedFlight
Most ECMO transport teams bring a perfusionist to focus on the circuit, but optimal patient care requires every team member to understand ECMO principles, anticipate complications, and contribute to problem-solving in transit. This session demystifies ECMO transport, breaking down the essentials in a concise, approachable way so that all providers—whether transport clinicians, respiratory therapists, nurses, or physicians—can play an active role in ensuring a safe and smooth transport.
Using real-world cases and interactive discussion, we will cover:
This high-yield, practical session ensures that every provider involved in ECMO transport is empowered to support the team, assist with troubleshooting, and recognize critical issues before they become life-threatening. Whether in the air or on the ground, ECMO transport is a team effort—this session will make sure you’re ready.