Paramedic-initiated Helivac to Tertiary Hospital for Primary Percutaneous Coronary Intervention: A Strategy for Improving Treatment Delivery Times

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aut.relation.issue5en_NZ
aut.relation.journalJournal of thoracic diseaseen_NZ
aut.relation.volume11en_NZ
aut.researcherHowie, Graham
dc.contributor.authorDavis, Pen_NZ
dc.contributor.authorHowie, GJen_NZ
dc.contributor.authorDicker, Ben_NZ
dc.contributor.authorGarrett, NKen_NZ
dc.date.accessioned2019-10-02T22:53:44Z
dc.date.available2019-10-02T22:53:44Z
dc.date.copyright2019-05en_NZ
dc.date.issued2019-05en_NZ
dc.description.abstractBackground: In regions of New Zealand without coronary catheterisation laboratory (CCL) facilities, patients presenting with ST-elevation myocardial infarction (STEMI) are often subjected to prolonged delays before receiving primary percutaneous coronary intervention (PPCI) if it is the chosen reperfusion strategy. Therefore, we aimed to trial a new process of paramedic-initiated helivac of STEMI patients from the field directly to the CCL. Methods: Utilising a prospective observational approach, over a 48-month period, paramedics identified patients with a clinical presentation and electrocardiogram features consistent with STEMI and transported them directly to the regional air ambulance base for helivac to the CCL (flight time 30–35 minutes). These patients were compared to two historic STEMI cohorts either transported by paramedics to the region’s local hospital or self-presenting, prior to helivac. The primary outcome measures were: first medical contact-to-balloon (FMCTB) time and accuracy of paramedic diagnosis. Secondary outcome measures were mortality at 30 days and six months, and hospital length of stay (LOS). Results: A total of 92 patients underwent helivac for PPCI (mean age of 64 years, SD ±10.3). Median FMCTB time was 155 minutes (IQR 27) for the historic cohorts (n=57), versus 102 minutes (IQR 16) for the experimental cohort (n=35, P<0.001). Paramedic diagnosis showed a sensitivity of 97% (95% CI: 85 to 99) and a specificity of 100% (95% CI: 84 to 100) with no inappropriate CCL activations. No significant difference was observed between groups in terms of 30 day and 6-month mortality. Hospital LOS was significantly shorter among the experimental cohort (P=0.01). Conclusions: Paramedic-initiated helivac of STEMI patients from the field directly to the CCL for PPCI is safe and feasible and can significantly improve time-to-treatment to within benchmark timeframes, resulting in reduced hospital LOS.
dc.identifier.citationJournal of Thoracic Disease, 11(5), 1819.
dc.identifier.doi10.21037/jtd.2019.05.45en_NZ
dc.identifier.issn2077-6624en_NZ
dc.identifier.urihttps://hdl.handle.net/10292/12866
dc.publisherAME Publishing Companyen_NZ
dc.relation.urihttp://jtd.amegroups.com/article/view/29037/21233
dc.rightsThis journal provides immediate open access to its content on the principle that making research freely available to the public supports a greater global exchange of knowledge.
dc.rights.accessrightsOpenAccessen_NZ
dc.subjectST-elevation myocardial infarction (STEMI); Percutaneous coronary intervention (PCI); Emergency medical services (EMS); Ambulances; Air ambulances
dc.titleParamedic-initiated Helivac to Tertiary Hospital for Primary Percutaneous Coronary Intervention: A Strategy for Improving Treatment Delivery Timesen_NZ
dc.typeJournal Article
pubs.elements-id364031
pubs.organisational-data/AUT
pubs.organisational-data/AUT/Health & Environmental Science
pubs.organisational-data/AUT/Health & Environmental Science/Clinical Sciences
pubs.organisational-data/AUT/PBRF
pubs.organisational-data/AUT/PBRF/PBRF Health and Environmental Sciences
pubs.organisational-data/AUT/PBRF/PBRF Health and Environmental Sciences/HH Clinical Sciences 2018 PBRF
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