Impact of Medical Evacuation From Mayotte to La Réunion on Intracranial Pressure in Pediatric Patients.

OBJECTIVE

Long-distance medical evacuation by ground, maritime, and fixed-wing air transport (EVASAN) from Mayotte to La Réunion is frequent for pediatric neurocritical patients. The impact of EVASAN on intracranial pressure (ICP) control is poorly documented, especially in this geographic and socioeconomic context. We aimed to analyze ICP variations during EVASAN and to describe associated physiological parameters and short-term outcomes.

METHODS

Retrospective cohort study of pediatric patients (< 18 lt; 18 years) evacuated from Mayotte to La Réunion between January 2019 and December 2024 with invasive ICP monitoring at departure (n = 22). ICP values and clinical variables (mean arterial pressure [MAP], heart rate [HR], oxygen saturation [SpO2], end-tidal carbon dioxide [EtCO2], fraction of inspired oxygen [FiO2], temperature, sedation, and vasopressor use) were extracted at predefined time points: initial (baseline), departure (intensive care unit), ferry transfer, takeoff, during flight, landing, and arrival at La Réunion pediatric intensive care unit. Primary outcome was ICP variation during EVASAN. Wilcoxon signed-rank tests compared paired time points; Spearman correlations explored associations. The study was approved under MR-004; consent was obtained as described.

RESULTS

A total of 22 patients (mean age 9.4 years, 73% pediatric traumatic brain injury) were included. The ferry phase was associated with a modest but statistically significant median increase in ICP (+ 5 mm Hg, P = .038). No sustained increase between departure and arrival was observed (median + 3 mm Hg, P = .251). FiO2 increased from a median of 0.3 to 0.4 (P = .008), whereas SpO2, MAP, HR, and EtCO2 remained stable. There was no correlation between ICP variation and 6-month Pediatric Glasgow Outcome Scale scores. Missing data and heterogeneity of care restricted inference.

CONCLUSION

In this single-center retrospective series, EVASAN was associated with transient ICP increases during the maritime ferry phase but not with sustained intracranial hypertension at arrival nor worse mid-term neurological outcome.