Transport time and care processes for patients transferred with ST-segment-elevation myocardial infarction: the reperfusion in acute myocardial infarction in Carolina emergency rooms experience.

Muñoz D, Roettig ML, Monk L, Al-Khalidi H, Jollis JG, Granger CB
Circ Cardiovasc Interv. 2012 5 (4): 555-62

PMID: 22872054 · PMCID: PMC3600977 · DOI:10.1161/CIRCINTERVENTIONS.112.968461

BACKGROUND - For patients with ST-segment elevation myocardial infarction transferred for primary percutaneous coronary intervention, guidelines have called for device activation within 90 minutes of initial presentation. Fewer than 20% of transferred patients are treated in such a timely fashion. We examine the association between transfer drive times and door-to-device (D2D) times in a network of North Carolina hospitals. We compare the feasibility of timely percutaneous coronary intervention using ground versus air transfer.

METHODS AND RESULTS - We perform a retrospective analysis of the relationship between transfer drive times and D2D times in a 119-hospital ST-segment-elevation myocardial infarction statewide network. Between July 2008 and December 2009, 1537 ST-segment-elevation myocardial infarction patients underwent interhospital transfer for reperfusion via primary percutaneous coronary intervention. For ground transfers, median D2D time was 93 minutes for drive times ≤30 minutes, 117 minutes for drive times of 31 to 45 minutes, and 121 minutes for drive times >45 minutes. For air transfers, median D2D time was 125 minutes for drive times of 31 to 45 minutes and 138 minutes for drive times >45 minutes. Helicopter transport was associated with longer door-in door-out times and, ultimately, was associated with median D2D times that exceeded guideline recommendations, no matter the transfer drive time category.

CONCLUSIONS - In a well-developed ST-segment-elevation myocardial infarction system, D2D times within 90 to 120 minutes appear most feasible for hospitals within 30-minute transfer drive time. Helicopter transport did not offer D2D time advantages for transferred STEMI patients. This finding appears to be attributable to comparably longer door-in door-out times for air transfers.

MeSH Terms (20)

Air Ambulances Ambulances Electrocardiography Emergency Service, Hospital Feasibility Studies Female Fibrinolysis Humans Male Middle Aged Morbidity Myocardial Infarction Myocardial Reperfusion North Carolina Patient Transfer Practice Guidelines as Topic Registries Retrospective Studies Time-to-Treatment Transportation of Patients

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