Early tPA treatment and aeromedical transport of patients with acute myocardial infarction.
Over a 2-year period 192 patients with acute myocardial infarction (AMI) were transported by helicopter and treated with recombinant tissue-plasminogen activator (tPA).  All patients were entered into the Thrombolysis in Myocardial Infarction-Phase II (TIMI II) trial. Eighty-two of these patients were treated with tPA after aeromedical transport to a tertiary care center.  One hundred ten patients had tPA treatment initiated by the flight crew prior to transport.  The flight crews initiated therapy 28 +/- 11 minutes after arrival at the sending hospital.  The post-flight treated patients received the tPA bolus 82 +/- 20 minutes after arrival at the sending hospital (P less than .0001), and 41 +/- 18 minutes after arrival at the receiving hospital (P less than .0001). Based on enzyme and electrocardiographic changes, all patients in the study had a confirmed diagnosis of AMI before discharge.  Patients with inferior myocardial infarction (MI) treated with tPA in-flight were more likely to suffer from bradycardia and hypotension requiring atropine injection during transport than the post-flight treated patients or in-flight treated patients with anterior MI.  There was no in-flight mortality in either group.  Our experience indicates that patients with AMI can be transported safely during tPA therapy.  Also, a trained team whose sole responsibility is the early evaluation and initiation of therapy in a patient with AMI can function as accurately and significantly more rapidly than tertiary care emergency department and ICU personnel following identical protocols.
Spangler
D E
DE
Life Saver Flight Operations, Carraway Methodist Medical Center, Alabama.
Rogers
W J
WJ
Gore
J M
JM
Griffith
M
M
Maske
L E
LE
Morgan
T E
TE
Corrao
J
J
D000368:Aged; D000401:Aircraft; D001145:Arrhythmias, Cardiac; D005260:Female; D006801:Humans; D007022:Hypotension; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications / Q000188:drug therapy*; D015912:Thrombolytic Therapy / Q000379:methods; D013997:Time Factors; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage*