HEMS vs. EMS transfer for acute aortic dissection type A.
BACKGROUND
We thought to evaluate the impact of the mode of physician-based transportation (helicopter emergency medical service [HEMS] vs. ground-based emergency medical service [EMS]) on short- and long-term survival among patients suffering acute aortic dissection type A (AADA) as a primary end-point.


METHODS
One-hundred-seventy-seven AADA patients (59 +/- 13 years) were included who were admitted to a cardiothoracic surgery department with comprehensive transfer documentation. Cox proportional hazard models and log-rank tests were performed as well as Kaplan-Meier survival curves. Follow-up was 93% over 5 +/- 2(3/4) years.


RESULTS
Cox proportional hazard model found no mortality difference for HEMS versus EMS on primary transport (P = .5), as well as log-rank (Mantel Cox) on interhospital transport (P = 0.5). HEMS interhospital transfer was eightfold more expensive than EMS (HEMS, 3,871; EMS, 497; P = .01). Ninety-nine patients (56%) were alive at follow-up (mean survival, 1,153 days +/- 1,124). Mortality after surgery was 2% (3/177) within the first hour, 5% (8/177) within 6 hours, 6% (10/177) within 12 hours, 11% (20/177) within 24 hours, 13% (23/177) within 48 hours, 14% (25/177) within 72 hours, and 26% (46/177) within 30 days after surgery.


CONCLUSIONS
We found no advantage of survival rates among patients suffering from AADA who were transferred by either HEMS or EMS in primary or secondary transport. Although HEMS traveled a distance more than twofold longer than ground-based EMS at the same mission time, HEMS was eightfold more expensive than ground-based EMS in AADA.
Plastic, hand and reconstructive surgery, Hannover Medical School, Germany. kknobi@yahoo.com
Karsten
K
Knobloch
Imke
I
Dehn
Nawid
N
Khaladj
Christian
C
Hagl
Peter M
PM
Vogt
Axel
A
Haverich
D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000401:Aircraft; D000552:Ambulances; D000784:Aortic Dissection; D017545:Aortic Aneurysm, Thoracic; D004632:Emergency Medical Services / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D014187:Transportation of Patients / Q000379:methods*; D055815:Young Adult