Helicopter-based hospital transfer may not decrease STEMI treatment time
MedWire News: In the majority of cases, transferring ST-elevation myocardial infarction (STEMI) patients to percutaneous coronary intervention (PCI) centers by helicopter increases treatment time beyond the recommended 90 minutes, US study results indicate.
The process of activating helicopters is the main cause of treatment delay in these cases.
"Although some health care systems have been able to meet the 90-minute goal for up to three-quarters of patients, our results are more consistent with those of larger systems involving competing hospital and cardiology groups," explain the study authors, led by Jason McMullan from the University of Cincinnati in Ohio, USA.
Co-author William Hinckley, also from the University of Cincinnati, said: "The take-home point of our findings is certainly not that helicopter emergency medical service (HEMS) doesn't help STEMI heart attack patients; on the contrary, HEMS undoubtedly saves many lives in getting surburban and rural STEMI patients to cardiac catheterization labs for PCI as rapidly as possible."
He added: "Rather, the point is that calling the helicopter is... fast, but it's not instantaneous."
The research team assessed 179 STEMI patients (mean age 58 years) who were transferred from 16 referring, to six receiving Cincinnati hospitals by HEMS.
Writing in the Annals of Emergency Medicine, the researchers report that 140 patients were transferred for PCI, and only 3% of these received treatment within the recommended 90-minute door-to-balloon time (time from arrival at referring hospital to treatment by PCI in receiving hospital).
Indeed, the median door-to-balloon time was 131 minutes, with more than 50% receiving treatment over 2 hours after arrival at the emergency department of the referring hospital.
In addition, only 21% of patients received fibrinolytics before transfer.
The researchers conclude: "Our results suggest that when interhospital transfer is required, significant delays are introduced even when HEMS is used.
"We contend that in these situations, hospitals incapable of PCI should consider early fibrinolytic therapy."
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By Lauretta Ihonor