Confronting acute refractory respiratory distress syndrome (ARDS), refractory cardiogenic shock, post-cardiotomy failure, or severe pulmonary complications while away from home represents one of the most critical clinical scenarios in modern aeromedicine. Tertiary and quaternary healthcare networks across Delhi NCR, Mumbai, Bengaluru, Chennai, and Hyderabad frequently treat complex international referrals, multinational corporate executives, and overseas travelers…