Document Detail


Reperfusion is delayed beyond guideline recommendations in patients requiring interhospital helicopter transfer for treatment of ST-segment elevation myocardial infarction.
MedLine Citation:
PMID:  20952099     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
STUDY OBJECTIVE: Early reperfusion portends better outcomes for ST-segment elevation myocardial infarction (STEMI) patients. This investigation estimates the proportions of STEMI patients transported by a hospital-based helicopter emergency medical services (EMS) system who meet the goals of 90-minute door-to-balloon time for percutaneous coronary intervention or 30-minute door-to-needle time for fibrinolysis.
METHODS: This was a multicenter, retrospective chart review of STEMI patients flown by a hospital-based helicopter service in 2007. Included patients were transferred from an emergency department (ED) to a cardiac catheterization laboratory for primary or rescue percutaneous coronary intervention. Out-of-hospital, ED, and inpatient records were reviewed to determine door-to-balloon time and door-to-needle time. Data were abstracted with a priori definitions and criteria.
RESULTS: There were 179 subjects from 16 referring and 6 receiving hospitals. Mean age was 58 years, 68% were men, and 86% were white. One hundred forty subjects were transferred for primary percutaneous coronary intervention, of whom 29 had no intervention during catheterization. For subjects with intervention, door-to-balloon time exceeded 90 minutes in 107 of 111 cases (97%). Median door-to-balloon time was 131 minutes (interquartile range 114 to 158 minutes). Thirty-nine subjects (21%) received fibrinolytics before transfer, and 19 of 39 (49%) received fibrinolytics within 30 minutes. Median door-to-needle time was 31 minutes (interquartile range 23 to 45 minutes).
CONCLUSION: In this study, STEMI patients presenting to non-percutaneous coronary intervention facilities who are transferred to a percutaneous coronary intervention-capable hospital by helicopter EMS do not commonly receive fibrinolysis and rarely achieve percutaneous coronary intervention within 90 minutes. In similar settings, primary fibrinolysis should be considered while strategies to reduce the time required for subsequent interventional care are explored.
Authors:
Jason T McMullan; William Hinckley; Jared Bentley; Todd Davis; Gregory J Fermann; Matthew Gunderman; Kimberly Ward Hart; William A Knight; Christopher J Lindsell; April Shackleford; W Brian Gibler
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Publication Detail:
Type:  Journal Article; Multicenter Study     Date:  2010-10-16
Journal Detail:
Title:  Annals of emergency medicine     Volume:  57     ISSN:  1097-6760     ISO Abbreviation:  Ann Emerg Med     Publication Date:  2011 Mar 
Date Detail:
Created Date:  2011-02-28     Completed Date:  2011-04-22     Revised Date:  2013-08-22    
Medline Journal Info:
Nlm Unique ID:  8002646     Medline TA:  Ann Emerg Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  213-220.e1     Citation Subset:  AIM; IM    
Copyright Information:
Copyright © 2010 American College of Emergency Physicians. Published by Mosby, Inc. All rights reserved.
Affiliation:
Department of Emergency Medicine, University of Cincinnati, Cincinnati, OH, USA. jason.mcmullan@uc.edu
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MeSH Terms
Descriptor/Qualifier:
Air Ambulances* / statistics & numerical data
Angioplasty, Balloon, Coronary / statistics & numerical data
Female
Guideline Adherence
Humans
Male
Middle Aged
Myocardial Infarction / drug therapy,  therapy*
Myocardial Reperfusion* / adverse effects
Patient Transfer* / statistics & numerical data
Retrospective Studies
Thrombolytic Therapy / statistics & numerical data
Time Factors
Grant Support
ID/Acronym/Agency:
UL1 TR000077/TR/NCATS NIH HHS
Comments/Corrections
Comment In:
Ann Emerg Med. 2011 Dec;58(6):575-6; author reply 576   [PMID:  22098999 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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