Outcomes of physician-staffed versus non-physician-staffed helicopter transport for ST-elevation myocardial infarction

Sverrir I. Gunnarsson, Joseph Mitchell, Mary S. Busch, Brenda Larson, Shahyar Gharacholou, Zhanhai Li, Amish N. Raval

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Background-The effect of physician-staffed helicopter emergency medical service (HEMS) on ST-elevation myocardial infarction (STEMI) patient transfer is unknown. The purpose of this study was to evaluate the characteristics and outcomes of physicianstaffed HEMS (Physician-HEMS) versus non-physician-staffed (Standard-HEMS) in patients with STEMI. Methods and Results-We studied 398 STEMI patients transferred by either Physician-HEMS (n=327) or Standard-HEMS (n=71) for primary or rescue percutaneous coronary intervention at 2 hospitals between 2006 and 2014. Data were collected from electronic medical records and each institution's contribution to the National Cardiovascular Data Registry. Baseline characteristics were similar between groups. Median electrocardiogram-to-balloon time was longer for the Standard-HEMS group than for the Physician-HEMS group (118 vs 107 minutes; P=0.002). The Standard-HEMS group was more likely than the Physician- HEMS group to receive nitroglycerin (37% vs 15%; P<0.001) and opioid analgesics (42.3% vs 21.7%; P<0.001) during transport. In-hospital adverse outcomes, including cardiac arrest, cardiogenic shock, and serious arrhythmias, were more common in the Standard-HEMS group (25.4% vs 11.3%; P=0.002). After adjusting for age, sex, Killip class, and transport time, patients transferred by Standard-HEMS had increased risk of any serious in-hospital adverse event (odds ratio=2.91; 95% CI=1.39-6.06; P=0.004). In-hospital mortality was not statistically different between the 2 groups (9.9% in the Standard-HEMS group vs 4.9% in the Physician-HEMS group; P=0.104). Conclusions-Patients with STEMI transported by Standard-HEMS had longer transport times, higher rates of nitroglycerin and opioid administration, and higher rates of adjusted in-hospital events. Efforts to better understand optimal transport strategies in STEMI patients are needed.

Original languageEnglish (US)
Article numbere004936
JournalJournal of the American Heart Association
Volume6
Issue number2
DOIs
StatePublished - Jan 1 2017

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Aircraft
Emergency Medical Services
Physicians
Nitroglycerin
Opioid Analgesics
ST Elevation Myocardial Infarction
Patient Transfer
Cardiogenic Shock
Electronic Health Records
Percutaneous Coronary Intervention
Hospital Mortality
Heart Arrest
Registries
Cardiac Arrhythmias
Electrocardiography
Odds Ratio

Keywords

  • Acute myocardial infarction
  • Outcome
  • Percutaneous coronary intervention
  • ST-segment elevation myocardial infarction
  • Treatment

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Outcomes of physician-staffed versus non-physician-staffed helicopter transport for ST-elevation myocardial infarction. / Gunnarsson, Sverrir I.; Mitchell, Joseph; Busch, Mary S.; Larson, Brenda; Gharacholou, Shahyar; Li, Zhanhai; Raval, Amish N.

In: Journal of the American Heart Association, Vol. 6, No. 2, e004936, 01.01.2017.

Research output: Contribution to journalArticle

Gunnarsson, Sverrir I. ; Mitchell, Joseph ; Busch, Mary S. ; Larson, Brenda ; Gharacholou, Shahyar ; Li, Zhanhai ; Raval, Amish N. / Outcomes of physician-staffed versus non-physician-staffed helicopter transport for ST-elevation myocardial infarction. In: Journal of the American Heart Association. 2017 ; Vol. 6, No. 2.
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abstract = "Background-The effect of physician-staffed helicopter emergency medical service (HEMS) on ST-elevation myocardial infarction (STEMI) patient transfer is unknown. The purpose of this study was to evaluate the characteristics and outcomes of physicianstaffed HEMS (Physician-HEMS) versus non-physician-staffed (Standard-HEMS) in patients with STEMI. Methods and Results-We studied 398 STEMI patients transferred by either Physician-HEMS (n=327) or Standard-HEMS (n=71) for primary or rescue percutaneous coronary intervention at 2 hospitals between 2006 and 2014. Data were collected from electronic medical records and each institution's contribution to the National Cardiovascular Data Registry. Baseline characteristics were similar between groups. Median electrocardiogram-to-balloon time was longer for the Standard-HEMS group than for the Physician-HEMS group (118 vs 107 minutes; P=0.002). The Standard-HEMS group was more likely than the Physician- HEMS group to receive nitroglycerin (37{\%} vs 15{\%}; P<0.001) and opioid analgesics (42.3{\%} vs 21.7{\%}; P<0.001) during transport. In-hospital adverse outcomes, including cardiac arrest, cardiogenic shock, and serious arrhythmias, were more common in the Standard-HEMS group (25.4{\%} vs 11.3{\%}; P=0.002). After adjusting for age, sex, Killip class, and transport time, patients transferred by Standard-HEMS had increased risk of any serious in-hospital adverse event (odds ratio=2.91; 95{\%} CI=1.39-6.06; P=0.004). In-hospital mortality was not statistically different between the 2 groups (9.9{\%} in the Standard-HEMS group vs 4.9{\%} in the Physician-HEMS group; P=0.104). Conclusions-Patients with STEMI transported by Standard-HEMS had longer transport times, higher rates of nitroglycerin and opioid administration, and higher rates of adjusted in-hospital events. Efforts to better understand optimal transport strategies in STEMI patients are needed.",
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AU - Gunnarsson, Sverrir I.

AU - Mitchell, Joseph

AU - Busch, Mary S.

AU - Larson, Brenda

AU - Gharacholou, Shahyar

AU - Li, Zhanhai

AU - Raval, Amish N.

PY - 2017/1/1

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N2 - Background-The effect of physician-staffed helicopter emergency medical service (HEMS) on ST-elevation myocardial infarction (STEMI) patient transfer is unknown. The purpose of this study was to evaluate the characteristics and outcomes of physicianstaffed HEMS (Physician-HEMS) versus non-physician-staffed (Standard-HEMS) in patients with STEMI. Methods and Results-We studied 398 STEMI patients transferred by either Physician-HEMS (n=327) or Standard-HEMS (n=71) for primary or rescue percutaneous coronary intervention at 2 hospitals between 2006 and 2014. Data were collected from electronic medical records and each institution's contribution to the National Cardiovascular Data Registry. Baseline characteristics were similar between groups. Median electrocardiogram-to-balloon time was longer for the Standard-HEMS group than for the Physician-HEMS group (118 vs 107 minutes; P=0.002). The Standard-HEMS group was more likely than the Physician- HEMS group to receive nitroglycerin (37% vs 15%; P<0.001) and opioid analgesics (42.3% vs 21.7%; P<0.001) during transport. In-hospital adverse outcomes, including cardiac arrest, cardiogenic shock, and serious arrhythmias, were more common in the Standard-HEMS group (25.4% vs 11.3%; P=0.002). After adjusting for age, sex, Killip class, and transport time, patients transferred by Standard-HEMS had increased risk of any serious in-hospital adverse event (odds ratio=2.91; 95% CI=1.39-6.06; P=0.004). In-hospital mortality was not statistically different between the 2 groups (9.9% in the Standard-HEMS group vs 4.9% in the Physician-HEMS group; P=0.104). Conclusions-Patients with STEMI transported by Standard-HEMS had longer transport times, higher rates of nitroglycerin and opioid administration, and higher rates of adjusted in-hospital events. Efforts to better understand optimal transport strategies in STEMI patients are needed.

AB - Background-The effect of physician-staffed helicopter emergency medical service (HEMS) on ST-elevation myocardial infarction (STEMI) patient transfer is unknown. The purpose of this study was to evaluate the characteristics and outcomes of physicianstaffed HEMS (Physician-HEMS) versus non-physician-staffed (Standard-HEMS) in patients with STEMI. Methods and Results-We studied 398 STEMI patients transferred by either Physician-HEMS (n=327) or Standard-HEMS (n=71) for primary or rescue percutaneous coronary intervention at 2 hospitals between 2006 and 2014. Data were collected from electronic medical records and each institution's contribution to the National Cardiovascular Data Registry. Baseline characteristics were similar between groups. Median electrocardiogram-to-balloon time was longer for the Standard-HEMS group than for the Physician-HEMS group (118 vs 107 minutes; P=0.002). The Standard-HEMS group was more likely than the Physician- HEMS group to receive nitroglycerin (37% vs 15%; P<0.001) and opioid analgesics (42.3% vs 21.7%; P<0.001) during transport. In-hospital adverse outcomes, including cardiac arrest, cardiogenic shock, and serious arrhythmias, were more common in the Standard-HEMS group (25.4% vs 11.3%; P=0.002). After adjusting for age, sex, Killip class, and transport time, patients transferred by Standard-HEMS had increased risk of any serious in-hospital adverse event (odds ratio=2.91; 95% CI=1.39-6.06; P=0.004). In-hospital mortality was not statistically different between the 2 groups (9.9% in the Standard-HEMS group vs 4.9% in the Physician-HEMS group; P=0.104). Conclusions-Patients with STEMI transported by Standard-HEMS had longer transport times, higher rates of nitroglycerin and opioid administration, and higher rates of adjusted in-hospital events. Efforts to better understand optimal transport strategies in STEMI patients are needed.

KW - Acute myocardial infarction

KW - Outcome

KW - Percutaneous coronary intervention

KW - ST-segment elevation myocardial infarction

KW - Treatment

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