Aeromedical transfer to reduce delay in primary angioplasty

详细信息    查看全文

• 作者：Matthew Balerdi^a ; Daniel Y. Ellis^b ; ¹ ; Philip Grieve^b ; Paul Murray^c ; Miles Dalby^a ; ^{m.dalby@rbht.nhs.uk"" rel=""nofollow}
• 关键词：Acute myocardial infarction ; Helicopter retrieval ; Emergency ambulance system ; Dispatch ; Cardiac care
• 刊名：Resuscitation
• 出版年：2011
• 出版时间：July 2011
• 年：2011
• 卷：82
• 期：7
• 页码：947-950
• 全文大小：321 K

文摘

Background

Aeromedical transfer can reduce transfer times for primary percutaneous coronary intervention (PPCI). Delays in dispatch of the helicopter and landing-reperfusion can reduce the benefits of air travel. The ad hoc nature of these transfers may compound delays. A formal aeromedical transfer service, with rapid dispatch protocols and rapid landing to balloon times could significantly reduce reperfusion times.

Methods

A standard operating procedure (SOP) was developed using a field assessment team (doctor, aircrew paramedic) and a cardiologist-led multidisciplinary team meeting the incoming aircraft. The aeromedical SOP for STEMI care was implemented when anticipated land journey >30 min to the nearest PPCI centre. Reperfusion times for actual air travel and estimated virtual land journeys from the same location were compared.

Results

Between April and December 2009, 8 patients were managed according to the aeromedical SOP. Median air distance 49 miles and road, 40 miles. All subsequent data shown in median minutes (range). Call-balloon time 109 (97–116). Call-aeromedical activation 13 (9–26). Aeromedical activation-arrive scene 12 (9–16). Time at scene 29 (24–52). Call-depart scene 57 (45–75). Air journey 25 (18–30) and landing-balloon 21 (8–22). Call-arrive at PPCI centre for air 85 (70–95); estimated virtual road call-arrive at PPCI centre 102 (85–104).

Conclusions

This SOP delivered sub 120 min call-balloon times in all cases undergoing PPCI from difficult locations where anticipated land journeys were >30 min. With longer anticipated land journeys (or more remote locations) the proportional gains with air transfer will be greater. Subject to a formal SOP and very rapid landing-balloon times, aeromedical transfer can significantly reduce the number of patients suffering long reperfusion delays in acute myocardial infarction.