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Open Access Original research

Earlier reperfusion in patients with ST-elevation Myocardial infarction by use of helicopter

Lars Knudsen123*, Carsten Stengaard4, Troels Martin Hansen123, Jens Flensted Lassen4 and Christian Juhl Terkelsen4

Author Affiliations

1 Helicopter Emergency Medical Service, Central Denmark Region, Aarhus, Denmark

2 Department of Prehospital Medical Services, Central Denmark Region, Aarhus, Denmark

3 Department of anesthesiology, Aarhus University Hospital, Nørrebrogade, 8000, Aarhus, Denmark

4 Department of cardiology B, Aarhus University Hospital in Skejby, Aarhus, Denmark

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Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine 2012, 20:70  doi:10.1186/1757-7241-20-70

Published: 4 October 2012

Abstract

Background

In patients with ST-elevation myocardial infarction (STEMI) reperfusion therapy should be initiated as soon as possible. This study evaluated whether use of a helicopter for transportation of patients is associated with earlier initiation of reperfusion therapy.

Material and methods

A prospective study was conducted, including patients with STEMI and symptom duration less than 12 hours, who had primary percutaneous coronary intervention (PPCI) performed at Aarhus University Hospital in Skejby. Patients with a health care system delay (time from emergency call to first coronary intervention) of more than 360 minutes were excluded. The study period ran from 1.1.2011 until 31.12.2011. A Western Denmark Helicopter Emergency Medical Service (HEMS) project was initiated 1.6.2011 for transportation of patients with time-critical illnesses, including STEMI.

Results

The study population comprised 398 patients, of whom 376 were transported by ambulance Emergency Medical Service (EMS) and 22 by HEMS. Field-triage directly to the PCI-center was used in 338 of patients. The median system delay was 94 minutes among those field-triaged, and 168 minutes among those initially admitted to a local hospital. Patients transported by EMS and field-triaged were stratified into four groups according to transport distance from the scene of event to the PCI-center: ≤25 km., 26–50 km., 51–75 km. and > 75 km. For these groups, the median system delay was 78, 89, 99, and 141 minutes. Among patients transported by HEMS and field-triaged the estimated median transport distance by ground transportation was 115 km, and the observed system delay was 107 minutes. Based on second order polynomial regression, it was estimated that patients with a transport distance of >60 km to the PCI-center may benefit from helicopter transportation, and that transportation by helicopter is associated with a system delay of less than 120 minutes even at a transport distance up to 150 km.

Conclusion

The present study indicates that use of a helicopter should be considered for field-triage of patients with STEMI to the PCI-center in case of long transportation. Such a strategy may ensure that patients living up to 150 km. from the PCI-center can be treated within 120 minutes of emergency call.

Keywords:
STEMI; Angioplasty; HEMS; Helicopter; Field-triage; System delay