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He developed acute respiratory distress syndrome, acute renal failure, hypotension requiring multiple pressors, and fluid overload necessitating bilateral chest tubes and two peritoneal drains. A pediatric critical care air transport team departed San Antonio within 36\u2009hours of activation and transported the patient via C-17 to Hawaii, performing a tail swap to a KC-135. Before takeoff, mechanical delays caused prolonged ground time and lack of temperature control resulted in patient\u2019s hyperthermia to reach 104.2\u00b0F despite the ice packing. The ambient temperature caused equipment malfunction (suction, handheld blood analyzer, and ventilator), necessitating manual bagging. Despite initial temperature challenges, the team removed 700\u2009mL of peritoneal fluid and substantially reduced the patient\u2019s ventilator settings. After 22\u2009hours of care, the team arrived with the patient to a civilian pediatric intensive care unit in CA, USA. Over several weeks, the patient made a full recovery. This pediatric critical care air transport mission highlights the complications intrinsic to air transport. Missions of this severity and length benefit from utilization of pediatric specialists to minimize morbidity and mortality. Highlighting the challenges related to preparation, air frame, and equipment malfunction should help others prepare for future pediatric air transports.<\/jats:p>","DOI":"10.1093\/milmed\/usae013","type":"journal-article","created":{"date-parts":[[2024,2,8]],"date-time":"2024-02-08T18:50:11Z","timestamp":1707418211000},"page":"e1765-e1770","source":"Crossref","is-referenced-by-count":1,"title":["When a Critically Ill Child is Oceans Away From a PICU: A Military Pediatric CCAT Mission"],"prefix":"10.1093","volume":"189","author":[{"ORCID":"https:\/\/orcid.org\/0009-0007-1499-1588","authenticated-orcid":false,"given":"Kevin M","family":"Brinkman","sequence":"first","affiliation":[{"name":"San Antonio Uniformed Services Education Consortium, Department of Pediatrics, Brooke Army Medical Center , JBSA-Fort Sam Houston, TX 78234, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Luke","family":"Zabrocki","sequence":"additional","affiliation":[{"name":"Department of 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