Paul Davis1,2, Graham J Howie2, Bridget Dicker1,2, Nicholas K Garrett3. 1. Clinical Audit and Research Team, St John Ambulance Service, Auckland, New Zealand. 2. Department of Paramedicine, School of Clinical Sciences, Auckland University of Technology, Auckland, New Zealand. 3. Biostatistics and Epidemiology, Faculty of Health and Environmental Science, Auckland University of Technology, Auckland, New Zealand.
Abstract
BACKGROUND: In regions of New Zealand without coronary catheterisation laboratory (CCL) facilities, patients presenting with ST-elevation myocardial infarction (STEMI) are often subjected to prolonged delays before receiving primary percutaneous coronary intervention (PPCI) if it is the chosen reperfusion strategy. Therefore, we aimed to trial a new process of paramedic-initiated helivac of STEMI patients from the field directly to the CCL. METHODS: Utilising a prospective observational approach, over a 48-month period, paramedics identified patients with a clinical presentation and electrocardiogram features consistent with STEMI and transported them directly to the regional air ambulance base for helivac to the CCL (flight time 30-35 minutes). These patients were compared to two historic STEMI cohorts either transported by paramedics to the region's local hospital or self-presenting, prior to helivac. The primary outcome measures were: first medical contact-to-balloon (FMCTB) time and accuracy of paramedic diagnosis. Secondary outcome measures were mortality at 30 days and six months, and hospital length of stay (LOS). RESULTS: A total of 92 patients underwent helivac for PPCI (mean age of 64 years, SD ±10.3). Median FMCTB time was 155 minutes (IQR 27) for the historic cohorts (n=57), versus 102 minutes (IQR 16) for the experimental cohort (n=35, P<0.001). Paramedic diagnosis showed a sensitivity of 97% (95% CI: 85 to 99) and a specificity of 100% (95% CI: 84 to 100) with no inappropriate CCL activations. No significant difference was observed between groups in terms of 30 day and 6-month mortality. Hospital LOS was significantly shorter among the experimental cohort (P=0.01). CONCLUSIONS: Paramedic-initiated helivac of STEMI patients from the field directly to the CCL for PPCI is safe and feasible and can significantly improve time-to-treatment to within benchmark timeframes, resulting in reduced hospital LOS.
BACKGROUND: In regions of New Zealand without coronary catheterisation laboratory (CCL) facilities, patients presenting with ST-elevation myocardial infarction (STEMI) are often subjected to prolonged delays before receiving primary percutaneous coronary intervention (PPCI) if it is the chosen reperfusion strategy. Therefore, we aimed to trial a new process of paramedic-initiated helivac of STEMI patients from the field directly to the CCL. METHODS: Utilising a prospective observational approach, over a 48-month period, paramedics identified patients with a clinical presentation and electrocardiogram features consistent with STEMI and transported them directly to the regional air ambulance base for helivac to the CCL (flight time 30-35 minutes). These patients were compared to two historic STEMI cohorts either transported by paramedics to the region's local hospital or self-presenting, prior to helivac. The primary outcome measures were: first medical contact-to-balloon (FMCTB) time and accuracy of paramedic diagnosis. Secondary outcome measures were mortality at 30 days and six months, and hospital length of stay (LOS). RESULTS: A total of 92 patients underwent helivac for PPCI (mean age of 64 years, SD ±10.3). Median FMCTB time was 155 minutes (IQR 27) for the historic cohorts (n=57), versus 102 minutes (IQR 16) for the experimental cohort (n=35, P<0.001). Paramedic diagnosis showed a sensitivity of 97% (95% CI: 85 to 99) and a specificity of 100% (95% CI: 84 to 100) with no inappropriate CCL activations. No significant difference was observed between groups in terms of 30 day and 6-month mortality. Hospital LOS was significantly shorter among the experimental cohort (P=0.01). CONCLUSIONS: Paramedic-initiated helivac of STEMI patients from the field directly to the CCL for PPCI is safe and feasible and can significantly improve time-to-treatment to within benchmark timeframes, resulting in reduced hospital LOS.
Entities:
Keywords:
ST-elevation myocardial infarction (STEMI); air ambulances; ambulances; emergency medical services (EMS); percutaneous coronary intervention (PCI)
Authors: Cindy L Grines; Donald R Westerhausen; Lorelei L Grines; J Timothy Hanlon; Timothy L Logemann; Matti Niemela; W Douglas Weaver; Marianne Graham; Judith Boura; William W O'Neill; Carlos Balestrini Journal: J Am Coll Cardiol Date: 2002-06-05 Impact factor: 24.094
Authors: Thomas Aversano; Lynnet T Aversano; Eugene Passamani; Genell L Knatterud; Michael L Terrin; David O Williams; Sandra A Forman Journal: JAMA Date: 2002-04-17 Impact factor: 56.272
Authors: Chris Ellis; Gerald Devlin; Philip Matsis; John Elliott; Michael Williams; Greg Gamble; Stewart Mann; John French; Harvey White Journal: N Z Med J Date: 2004-07-09
Authors: Henning R Andersen; Torsten T Nielsen; Klaus Rasmussen; Leif Thuesen; Henning Kelbaek; Per Thayssen; Ulrik Abildgaard; Flemming Pedersen; Jan K Madsen; Peer Grande; Anton B Villadsen; Lars R Krusell; Torben Haghfelt; Preben Lomholt; Steen E Husted; Else Vigholt; Henrik K Kjaergard; Leif Spange Mortensen Journal: N Engl J Med Date: 2003-08-21 Impact factor: 91.245
Authors: P Widimský; T Budesínský; D Vorác; L Groch; M Zelízko; M Aschermann; M Branny; J St'ásek; P Formánek Journal: Eur Heart J Date: 2003-01 Impact factor: 29.983