Published March 23, 2025

Highest Altitude Rescue by Medicity Hospital

Case Report

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

Author links open overlay panelDhirendra Kumar Malla MBBS, MDGP ¹, Sanij Singh MBBS, MDGP ¹, Yuvraj Basnet MBBS, MDGP ¹, Abhijit Adhikary MBBS, MD ¹, Vijay Chaudhary MBBS, MDGP ¹, Ekadev Neupane EMT ¹, Deepak Ghimire MBBS, MD ¹, Anish Baniya MBBS ², Vincent O'Neill MD ³, Sanjaya Karki MBBS, MD, DAvMed ¹

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https://doi.org/10.1016/j.amj.2022.11.001 Get rights and content

Abstract

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.

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Case Report

The patient was a 30-year-old male trekker not on prophylactic acetazolamide with a previous history of high-altitude illness 8 years prior, although no other details are known about his previous history. On this occasion, the patient became ill while trekking at Shey Phoksundo region (3,600 m) and ultimately was evacuated to Nepal Mediciti Hospital on November 1, 2021, after being intubated by responders at an altitude of 3,600 m. Prehospital intubations at this altitude are very rare in Nepal.

Discussion

When increased pulmonary vasoconstriction occurs secondary to hypoxia, an increase in pulmonary capillary pressure may result in increased capillary leakage, ultimately leading to pulmonary edema.⁴

Another case was published in the literature in which, at an altitude of 4,200 m in Pheriche, Nepal, endotracheal intubation was performed in the context of a cardiopulmonary arrest secondary to HAPE.⁵ However, such high-altitude intubations are rare in Nepal because of the general unavailability of

Conclusion

In Nepal, helicopter rescue operations involving advanced medical teams are being conducted by only a few hospitals, and many in the country are still unaware of the existence of or methods of accessing these services. It is advisable to arrange a rescue plan in advance before engaging in high-altitude trekking or climbing in the Nepali Himalayas because such proactive arrangements can mean the difference between life and death in an emergency. Unfortunately, insurance policies covering

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