Document Detail


Transport time and care processes for patients transferred with ST-segment-elevation myocardial infarction: the reperfusion in acute myocardial infarction in Carolina emergency rooms experience.
MedLine Citation:
PMID:  22872054     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: For patients with ST-segment elevation myocardial infarction transferred for primary percutaneous coronary intervention, guidelines have called for device activation within 90 minutes of initial presentation. Fewer than 20% of transferred patients are treated in such a timely fashion. We examine the association between transfer drive times and door-to-device (D2D) times in a network of North Carolina hospitals. We compare the feasibility of timely percutaneous coronary intervention using ground versus air transfer.
METHODS AND RESULTS: We perform a retrospective analysis of the relationship between transfer drive times and D2D times in a 119-hospital ST-segment-elevation myocardial infarction statewide network. Between July 2008 and December 2009, 1537 ST-segment-elevation myocardial infarction patients underwent interhospital transfer for reperfusion via primary percutaneous coronary intervention. For ground transfers, median D2D time was 93 minutes for drive times ≤30 minutes, 117 minutes for drive times of 31 to 45 minutes, and 121 minutes for drive times >45 minutes. For air transfers, median D2D time was 125 minutes for drive times of 31 to 45 minutes and 138 minutes for drive times >45 minutes. Helicopter transport was associated with longer door-in door-out times and, ultimately, was associated with median D2D times that exceeded guideline recommendations, no matter the transfer drive time category.
CONCLUSIONS: In a well-developed ST-segment-elevation myocardial infarction system, D2D times within 90 to 120 minutes appear most feasible for hospitals within 30-minute transfer drive time. Helicopter transport did not offer D2D time advantages for transferred STEMI patients. This finding appears to be attributable to comparably longer door-in door-out times for air transfers.
Authors:
Daniel Muñoz; Mayme L Roettig; Lisa Monk; Hussein Al-Khalidi; James G Jollis; Christopher B Granger
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't     Date:  2012-08-07
Journal Detail:
Title:  Circulation. Cardiovascular interventions     Volume:  5     ISSN:  1941-7632     ISO Abbreviation:  Circ Cardiovasc Interv     Publication Date:  2012 Aug 
Date Detail:
Created Date:  2012-08-16     Completed Date:  2012-12-10     Revised Date:  2014-03-19    
Medline Journal Info:
Nlm Unique ID:  101499602     Medline TA:  Circ Cardiovasc Interv     Country:  United States    
Other Details:
Languages:  eng     Pagination:  555-62     Citation Subset:  IM    
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MeSH Terms
Descriptor/Qualifier:
Air Ambulances / standards,  statistics & numerical data
Ambulances / standards,  statistics & numerical data
Electrocardiography
Emergency Service, Hospital / organization & administration,  standards,  statistics & numerical data*
Feasibility Studies
Female
Fibrinolysis
Humans
Male
Middle Aged
Morbidity
Myocardial Infarction / diagnosis,  mortality,  therapy*
Myocardial Reperfusion*
North Carolina / epidemiology
Patient Transfer / standards,  statistics & numerical data
Practice Guidelines as Topic
Registries / statistics & numerical data
Retrospective Studies
Time-to-Treatment / standards,  statistics & numerical data*
Transportation of Patients / organization & administration,  standards,  statistics & numerical data*
Grant Support
ID/Acronym/Agency:
T32 HL007411/HL/NHLBI NIH HHS
Comments/Corrections

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


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