Improving bedside to departure care in air transport of ST segment elevation myocardial infarction patients: a 2-year retrospective study of performance.
BACKGROUND
Rapid treatment after the initial diagnosis of an ST segment elevation myocardial infarction (STEMI) is critical to ensure positive outcomes. The objective of the study was to evaluate time-sensitive indicators adversely affecting performance during helicopter transport of STEMI patients from remote areas to a percutaenous coronary intervention (PCI) facility. A particular focus was to examine confounding factors that affected the time from arrival at bedside/event to the time of departure to a PCI facility.


METHODS
A 24-month retrospective chart audit of STEMI cases was undertaken. Data from initial liftoff to return of the patient from a referring facility were tracked for time-sequencing and patterns of events that lead to delayed transport. The standard deviation was used to assess abnormal variances.


RESULTS
No deaths were recorded from any of the 32 cases identified for inclusion in the study, and survival analysis was unobtainable. There was a significant correlation (r = 0.613, P = .0001) between time spent on the ground stabilizing the patient and total mission time. The need for the transport team to initiate vasopressor therapy was the most cited reason for delay in liftoff to the receiving facility.


CONCLUSIONS
Time from arrival at remote bedside and subsequent transfer to a PCI facility had the most variability. Enhancing communication times between referring agency and air medical personnel and stabilizing the patient before transport may be the most significant components in reducing transfer times and ensuring optimal outcomes.
McGrath
Christopher P
CP
Carolina Air Care UNC Hospitals, Chapel Hill, NC 27514, USA. cmcgrath@unch.unc.edu
Rosen
Glen S
GS
Bechtel
Gregory A
GA
D017732:Air Ambulances; D015906:Angioplasty, Balloon, Coronary; D004562:Electrocardiography; D006801:Humans; D009203:Myocardial Infarction / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy; D009657:North Carolina; D012189:Retrospective Studies; D016896:Treatment Outcome