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OUTCOMES OF PHYSICIAN-STAFFED VERSUS NON-PHYSICIAN STAFFED HELICOPTER TRANSPORT FOR ST-ELEVATION MYOCARDIAL INFARCTION
618 JACC April 5, 2016 Volume 67, Issue 13
Acute Coronary Syndromes OUTCOMES OF PHYSICIAN-STAFFED VERSUS NON-PHYSICIAN STAFFED HELICOPTER TRANSPORT FOR ST-ELEVATION MYOCARDIAL INFARCTION Poster Contributions Poster Area, South Hall A1 Sunday, April 03, 2016, 3:45 p.m.-4:30 p.m. Session Title: Acute Coronary Syndromes: Implementing the Known and the Novel to Improve Outcomes Abstract Category: 15. Acute Coronary Syndromes: Therapy Presentation Number: 1215-022 Authors: Sverrir Ingi Gunnarsson, Joseph Mitchell, Brenda Larson, Mary Busch, Zhanhai Li, S. Gharacholou, Amish Raval, University of Wisconsin, Madison, WI, USA, Mayo Clinic Health System, La Crosse, WI, USA
Background: Helicopter emergency medical services (HEMS) commonly transport patients with ST elevation myocardial infarction (STEMI) to medical centers performing percutaneous coronary intervention (PCI). Most HEMS consist of paramedics and nurses but a few centers employ emergency medicine trained physicians. The association of physician staffed HEMS on patient outcomes in this setting is unknown. Methods: Retrospective analysis of 377 STEMI patients transferred by either physician staffed HEMS (MD group) or non-physician staffed HEMS (No-MD group) for PCI at two medical centers between 2006 and 2014. Baseline demographics, transport time and medications were recorded. In-transport adverse events were defined as hypotension (systolic blood pressure ≤90 mmHg), arrhythmias or cardiac arrest.
Results: There were 327 patients transferred by MD and 50 patients by No-MD. Mean age, sex, risk factors and Killip class were similar between the groups. In-transport mortality was 0%. In-transport adverse events were more common in the No-MD group compared to the MD group (18% vs. 7%, p = 0.024). Mean (SD) initial electrocardiogram-to-balloon time (ECG2B) was longer for the No-MD group than for the MD group (119 ± 32 vs. 109 ± 22 min.; p = 0.04). The No-MD group was more likely than the MD group to receive nitroglycerin (38% vs. 15%, p < 0.001) and analgesics/anxiolytics (46% vs. 22%, p < 0.001) during transport. There was a trend towards increased in-hospital mortality in the No-MD group (12% vs. 5%, p = 0.056). In-hospital adverse events were more common in the No-MD group (30% vs. 11%, p = 0.001) including need for intra-aortic balloon pump (24% vs. 12%, p = 0.03). After adjusting for age, sex, Killip class and transport time, MD presence in-flight was independently associated with a reduced risk of in-transport adverse events (odds ratio [OR] = 0.31, 95% CI = 0.12-0.79, p = 0.014). Conclusions: Serious in-transport and in-hospital adverse events were more common in patients transferred by non-MD staffed helicopters. This could be explained by longer transport time and use of medications that may cause hypotension such as nitroglycerin.
Acute Coronary Syndromes OUTCOMES OF PHYSICIAN-STAFFED VERSUS NON-PHYSICIAN STAFFED HELICOPTER TRANSPORT FOR ST-ELEVATION MYOCARDIAL INFARCTION Poster Contributions Poster Area, South Hall A1 Sunday, April 03, 2016, 3:45 p.m.-4:30 p.m. Session Title: Acute Coronary Syndromes: Implementing the Known and the Novel to Improve Outcomes Abstract Category: 15. Acute Coronary Syndromes: Therapy Presentation Number: 1215-022 Authors: Sverrir Ingi Gunnarsson, Joseph Mitchell, Brenda Larson, Mary Busch, Zhanhai Li, S. Gharacholou, Amish Raval, University of Wisconsin, Madison, WI, USA, Mayo Clinic Health System, La Crosse, WI, USA
Background: Helicopter emergency medical services (HEMS) commonly transport patients with ST elevation myocardial infarction (STEMI) to medical centers performing percutaneous coronary intervention (PCI). Most HEMS consist of paramedics and nurses but a few centers employ emergency medicine trained physicians. The association of physician staffed HEMS on patient outcomes in this setting is unknown. Methods: Retrospective analysis of 377 STEMI patients transferred by either physician staffed HEMS (MD group) or non-physician staffed HEMS (No-MD group) for PCI at two medical centers between 2006 and 2014. Baseline demographics, transport time and medications were recorded. In-transport adverse events were defined as hypotension (systolic blood pressure ≤90 mmHg), arrhythmias or cardiac arrest.
Results: There were 327 patients transferred by MD and 50 patients by No-MD. Mean age, sex, risk factors and Killip class were similar between the groups. In-transport mortality was 0%. In-transport adverse events were more common in the No-MD group compared to the MD group (18% vs. 7%, p = 0.024). Mean (SD) initial electrocardiogram-to-balloon time (ECG2B) was longer for the No-MD group than for the MD group (119 ± 32 vs. 109 ± 22 min.; p = 0.04). The No-MD group was more likely than the MD group to receive nitroglycerin (38% vs. 15%, p < 0.001) and analgesics/anxiolytics (46% vs. 22%, p < 0.001) during transport. There was a trend towards increased in-hospital mortality in the No-MD group (12% vs. 5%, p = 0.056). In-hospital adverse events were more common in the No-MD group (30% vs. 11%, p = 0.001) including need for intra-aortic balloon pump (24% vs. 12%, p = 0.03). After adjusting for age, sex, Killip class and transport time, MD presence in-flight was independently associated with a reduced risk of in-transport adverse events (odds ratio [OR] = 0.31, 95% CI = 0.12-0.79, p = 0.014). Conclusions: Serious in-transport and in-hospital adverse events were more common in patients transferred by non-MD staffed helicopters. This could be explained by longer transport time and use of medications that may cause hypotension such as nitroglycerin.