HERMES: International Survey and Portable External Power Evaluation During Respiratory Support Transport (HERMES)

September 4, 2026 updated by: Berkan Basançelebi, Medipol University

Prehospital Transport During Advanced Respiratory Support: An International Survey and Prospective Feasibility Evaluation of Portable External Power

The HERMES Phase I-II study was a two-phase observational investigation designed to characterize contemporary practices and safety-related challenges associated with the transport of patients requiring advanced respiratory support and to assess the operational feasibility of portable external electrical power during ambulance transport.

Phase I consisted of an international electronic cross-sectional survey of healthcare professionals involved in noninvasive ventilation (NIV) management or patient transport. The survey evaluated reported transport indications, ventilator type and positioning, respiratory interfaces, transport-team composition, and perceived patient-, equipment-, and environment-related problems.

Phase II was a prospective descriptive feasibility evaluation involving 25 ambulance transports performed in Albacete and Bilbao, Spain. Patients were transported while receiving high-flow nasal oxygen (HFNO), rescue NIV, or invasive mechanical ventilation. A portable external power supply was used to support continuity of powered respiratory-support equipment during transport. The primary technical feasibility outcome was successful completion of transport while maintaining respiratory support without reported power interruption, clinically relevant equipment alarm, or technical failure.

The two phases were analyzed independently and were intended to characterize respiratory-support transport practices and evaluate technical and operational feasibility rather than establish comparative effectiveness, clinical superiority, or prevention of clinical deterioration.

Study Overview

Status

Completed

Conditions

Intervention / Treatment

Detailed Description

Patients receiving advanced respiratory support may require prehospital, interhospital, or intrahospital transport for diagnostic procedures, therapeutic interventions, transfer to a higher level of care, or continuation of acute management. Noninvasive ventilation and high-flow nasal oxygen are established forms of respiratory support in acute respiratory failure, while invasive mechanical ventilation remains necessary in patients with more severe or refractory respiratory failure. During transport, continuity of respiratory support must be maintained despite changes in environment, personnel, equipment configuration, oxygen availability, and electrical power supply.

Transport of critically ill patients represents a recognized period of increased clinical and technical vulnerability. International recommendations emphasize adequate stabilization before transport, appropriate physiologic monitoring, trained accompanying personnel, communication between clinical teams, verification of equipment function, sufficient oxygen and power reserves, and contingency planning for foreseeable clinical deterioration or device failure. Prospective cohort studies and systematic reviews have demonstrated that transport-associated adverse events may include physiologic deterioration, equipment malfunction, circuit or airway problems, interruptions in therapy, and organizational or communication failures. The reported frequency of such events varies substantially according to patient population, transport setting, event definitions, urgency, and surveillance methodology.

Against this background, the HERMES Phase I-II program was developed as two analytically distinct observational phases.

Phase I was an international electronic cross-sectional survey targeting healthcare professionals involved in NIV management or patient transport. The objective was to characterize reported clinical and organizational practices related to the transport of patients requiring noninvasive respiratory support and to identify perceived areas of vulnerability during transport.

The available survey records were timestamped from February 20 to May 6, 2023. The dataset contained 224 response records. Survey domains included indications for transport, type and positioning of ventilators, use of respiratory interfaces, composition of the transport team, and categories of patient-, equipment-, and environment-related problems.

The respondent record was the unit of analysis. Reported problems reflected respondents' perceptions or previous clinical experience and were therefore not interpreted as prospectively adjudicated adverse-event incidence. Because the available documentation did not establish the invitation denominator, recruitment channels, participating countries and institutions, reminder procedures, or a prespecified definition of questionnaire completion, a formal response rate and country- or institution-level prevalence estimates were not calculated.

The rationale for this phase was based on the recognized variability in transport organization and on the importance of standardized preparation, appropriately trained personnel, continuous monitoring, equipment checks, adequate resource planning, and predefined safety procedures. Structured transport protocols and checklists may further improve adherence to transport-safety recommendations and promote more consistent preparation before patient transfer.

Phase II was designed as a prospective descriptive feasibility evaluation of portable external electrical power during ambulance transport of patients requiring advanced respiratory support. Twenty-five transport episodes were prospectively recorded at participating units in Albacete and Bilbao, Spain. The cohort included 24 adults and one child.

Respiratory-support modalities included HFNO, rescue NIV, and invasive mechanical ventilation during cardiopulmonary resuscitation. A Zopec Transport UPS 90 external power supply was used during transport to support continuity of powered respiratory-support equipment. Respiratory-support devices, oxygen delivery, monitoring, and other aspects of clinical management remained determined by the treating clinical teams according to local practice.

The primary technical feasibility outcome was completion of ambulance transport while maintaining prescribed respiratory support without reported electrical power interruption, clinically relevant equipment alarm, or technical failure requiring corrective intervention. Additional descriptive variables included respiratory-support modality, transport duration, rescue respiratory support, technical events, operational complexity, and changes in respiratory support.

Electrical continuity represents an important component of transport safety because contemporary respiratory-support systems may depend simultaneou

Study Type

Observational

Enrollment (Actual)

246

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Locations

  • Chile
      • Punta Arenas, Chile
        • Intensive care Unit, Hospital General Ramos Mejia, Buenos Aires Argentina School of Medicine, University of Magallanes
      • Santiago, Chile
        • Faculty of Health Sciences, Universidad Autónoma de Chile
  • Croatia
      • Zagreb, Croatia
        • Department of Anaesthesiology and ICU, University Hospital Centre Zagreb
  • Egypt
      • Cairo, Egypt
        • Chest Department, Cairo University Hospitals
  • India
      • Mangalore, India
        • Department of Respiratory Medicine, Father Muller Medical College Hospital
  • Iran
      • Tehran, Iran
        • Shahid Beheshti University of Medical Sciences
  • Italy
      • Naples, Italy
        • Department of Critical Care, UOC Anesthesia, Postoperative Intensive Care and ECMO, Monaldi Hospital, AORN Ospedali dei Colli
  • Mexico
      • Mexico City, Mexico
        • Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Servicio de Neumología
  • Oman
      • Sohar, Oman
        • Department of Medicine, College of Medicine and Health Sciences, National University of Science and Technology
  • Qatar
      • Doha, Qatar
        • Heart Hospital, HMC
  • Saudi Arabia
      • Jeddah, Saudi Arabia
        • Department of Respiratory Therapy, Faculty of Medical Rehabilitation Sciences, King Abdulaziz University
  • Spain
      • Albacete, Spain
        • Mobile Emergency Unit of Albacete, Department of Urgent Care, Emergencies and Medical Transport of Castilla-La Mancha
      • Algeciras, Spain
        • Intensive Care Unit, Hospital Punta de Europa
      • Bilbao, Spain
        • Emergentziak, Osakidetza
      • Murcia, Spain
        • Intensive Care Unit. Hospital Morales Meseguer
  • Turkey (Türkiye)
      • Hatay, Turkey (Türkiye)
        • Department of Pulmonology, Tayfur Ata Sökmen Faculty of Medicine, Hatay Mustafa Kemal University
      • Istanbul, Turkey (Türkiye)
        • Istanbul Medipol University
  • United States
    • New York
      • Mount Kisco, New York, United States, 10549
        • Department Pulmonary Critical Care and Sleep Medicine Northwell Northern Westchester Hospital
  • Yemen
      • Sanaa, Yemen
        • Al-Razi University
      • Sanaa, Yemen
        • Department of Respiratory Therapy, Ibn- al-Nafis University for Medical Sciences

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

  • Child
  • Adult
  • Older Adult

Accepts Healthy Volunteers

No

Sampling Method

Non-Probability Sample

Study Population

The study population comprised two distinct groups. Phase I included healthcare professionals involved in noninvasive ventilation management or patient transport who participated in an international electronic cross-sectional survey addressing respiratory-support transport practices. Phase II included patients undergoing ambulance transport while receiving advanced respiratory support, including high-flow nasal oxygen, noninvasive ventilation, or invasive mechanical ventilation, in participating units in Albacete and Bilbao, Spain. The two populations were analyzed separately and were not statistically combined.

Description

Phase I - International Healthcare Professional Survey

Inclusion Criteria:

  • Healthcare professionals involved in the management of noninvasive ventilation or in the transport of patients requiring respiratory support.
  • Participation in the international electronic survey addressing respiratory-support transport practices.

Exclusion Criteria:

  • Records not representing participation in the respiratory-support transport survey.
  • Records lacking sufficient information for descriptive analysis of the predefined survey domains.

Phase II - Portable External Power Feasibility Evaluation

Inclusion Criteria:

  • Patients undergoing ambulance transport while receiving advanced respiratory support.
  • Receipt of high-flow nasal oxygen (HFNO), noninvasive ventilation (NIV), or invasive mechanical ventilation during the transport episode.
  • Transport performed at one of the participating clinical units included in the prospective feasibility evaluation.
  • Availability of transport-level data sufficient to evaluate continuity of respiratory support and the occurrence of power interruption, clinically relevant equipment alarm, or technical failure.

Exclusion Criteria:

  • Transport episodes not involving advanced respiratory support.
  • Transport episodes for which continuity of respiratory support or the primary technical feasibility outcome could not be determined.

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

Cohorts and Interventions

Group / Cohort
Intervention / Treatment
Phase I - International Healthcare Professional Survey
Healthcare professionals involved in noninvasive ventilation management or patient transport who participated in the international electronic cross-sectional survey. The survey assessed reported transport indications, ventilator type and positioning, respiratory-interface use, transport-team composition, and perceived patient-, equipment-, and environment-related problems. The survey dataset contained 224 response records corresponding to 221 unique respondents.
Phase II - Portable External Power Feasibility Cohort
Patients undergoing ambulance transport while receiving advanced respiratory support, including high-flow nasal oxygen, rescue noninvasive ventilation, or invasive mechanical ventilation. Portable external electrical power was prospectively evaluated for continuity of powered respiratory-support equipment during transport. Clinical management and respiratory-support decisions were determined according to routine clinical practice.
Device: Portable External Power Supply
A Zopec Transport UPS 90 portable external power supply was used during ambulance transport to provide continuous electrical power to powered respiratory-support equipment. The feasibility evaluation assessed maintenance of respiratory support during transport and the occurrence of power interruption, clinically relevant equipment alarms, or technical failure.

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Number and Percentage of Respondents Reporting Predefined Respiratory-Support Transport Practices
Time Frame: Baseline
Number and percentage of Phase I survey respondents reporting predefined respiratory-support transport practices, including transport indications, ventilator type and positioning, respiratory-interface use, and transport-team composition.
Baseline
Number and Percentage of Ambulance Transports Completed With Uninterrupted Respiratory Support
Time Frame: From departure from the point of origin to arrival at the intended destination (transport duration: 23-110 minutes)
Number and percentage of Phase II ambulance transport episodes completed with uninterrupted respiratory support and without reported electrical power interruption, clinically relevant equipment alarm, or technical failure. This outcome represented the primary technical feasibility measure of the portable external power evaluation.
From departure from the point of origin to arrival at the intended destination (transport duration: 23-110 minutes)

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Number and Percentage of Respondents Reporting Transport-Related Problems
Time Frame: Baseline
Number and percentage of Phase I survey respondents reporting patient-related, equipment-related, or environmental problems associated with respiratory-support transport. These responses reflected participants' reported perceptions or previous experience and did not represent prospectively adjudicated adverse-event incidence.
Baseline
Number and Percentage of Respondents Reporting Each Transport-Team Professional Category
Time Frame: Baseline
Number and percentage of Phase I survey respondents reporting the involvement of physicians, nurses, respiratory therapists, nursing assistants, or other healthcare personnel during respiratory-support transport. Multiple selections were permitted.
Baseline
Number and Percentage of Ambulance Transports by Respiratory-Support Modality
Time Frame: From departure from the point of origin to arrival at the intended destination (transport duration: 23-110 minutes)
Number and percentage of Phase II ambulance transport episodes involving high-flow nasal oxygen (HFNO), rescue noninvasive ventilation (NIV), or invasive mechanical ventilation.
From departure from the point of origin to arrival at the intended destination (transport duration: 23-110 minutes)
Number and Percentage of Patients Requiring Escalation or Modification of Respiratory Support
Time Frame: From departure from the point of origin to arrival at the intended destination (transport duration: 23-110 minutes)
Number and percentage of Phase II patients requiring escalation or clinically indicated modification of respiratory support during ambulance transport, including transition to rescue noninvasive ventilation or invasive mechanical ventilation.
From departure from the point of origin to arrival at the intended destination (transport duration: 23-110 minutes)
Number and Percentage of Ambulance Transports With Power Interruption, Clinically Relevant Equipment Alarm, or Technical Failure
Time Frame: From departure from the point of origin to arrival at the intended destination (transport duration: 23-110 minutes)
Number and percentage of Phase II ambulance transport episodes in which at least one electrical power interruption, clinically relevant equipment alarm, or technical failure was reported during use of the portable external power system.
From departure from the point of origin to arrival at the intended destination (transport duration: 23-110 minutes)
Ambulance Transport Duration in Minutes
Time Frame: From departure from the point of origin to arrival at the intended destination (transport duration: 23-110 minutes)
Duration of each Phase II ambulance transport episode, measured in minutes from departure from the point of origin to arrival at the intended destination. Transport duration was summarized using mean and standard deviation, median and interquartile range, and observed range.
From departure from the point of origin to arrival at the intended destination (transport duration: 23-110 minutes)

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Medipol University

Investigators

  • Study Director: Antonio Esquinas, Intensive Care Unit, Hospital Meseguer, Murcia, Spain
  • Study Chair: Berkan Basançelebi, Medipol University
  • Study Chair: Satheesh Munusamy, Heart Hospital, HMC, Qatar

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

General Publications

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Actual)

February 20, 2023

Primary Completion (Actual)

May 20, 2023

Study Completion (Actual)

February 20, 2025

Study Registration Dates

First Submitted

August 25, 2026

First Submitted That Met QC Criteria

September 1, 2026

First Posted (Actual)

September 8, 2026

Study Record Updates

Last Update Posted (Actual)

September 9, 2026

Last Update Submitted That Met QC Criteria

September 4, 2026

Last Verified

September 1, 2026

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

  • IANIV-HERMES-I-II

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

YES

IPD Plan Description

Deidentified individual participant data underlying the reported study results may be made available to qualified researchers upon reasonable request. Data sharing will be considered only for scientifically justified proposals and will be subject to approval by the HERMES Steering Committee, applicable ethics requirements, institutional policies, participant consent provisions, and relevant data-protection regulations. Data elements that could increase the risk of participant re-identification or that cannot be shared under applicable ethical, legal, or institutional requirements will not be provided. A data-use agreement may be required before access is granted.

IPD Sharing Time Frame

Deidentified individual participant data and available supporting information may be made available beginning 6 months after publication of the primary study results and for up to 5 years thereafter.

IPD Sharing Access Criteria

Deidentified individual participant data underlying the published results may be made available to qualified researchers upon reasonable request. Requests must include a scientifically justified and methodologically appropriate research proposal and will be reviewed by the HERMES Steering Committee. Access will be limited to data necessary for the approved analysis and will remain subject to applicable ethics approvals, participant consent provisions, institutional policies, and data-protection regulations. Variables that cannot be adequately deidentified or are restricted by ethical, legal, or institutional requirements will not be shared. A data-use agreement may be required before access is granted.

IPD Sharing Supporting Information Type

  • STUDY_PROTOCOL
  • ANALYTIC_CODE

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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