Air transport not always faster in heart attack cases




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BY SHEREEN JEGTVIG

NEW YORK – Switching helicopter to ground transport between two Texas hospitals cut the time heart had to wait to have their arteries unblocked by more half an hour, according to a new study.

“What we showed in our study by tweaking our , in this case by changing our mode transportation air to ground, we actually took median treatment time about 121 minutes beforehand to 90 minutes afterward,” Dr. Timothy Mixon told Reuters Health in a phone call.

“That’ about a 30 minute decrease in total treatment time by going by ground,” he said. “Although that seems slower, it really quicker.”

Mixon is an interventional cardiologist with Scott and White Healthcare in Temple, Texas. He and coauthor Dr. Luis Colato wrote the paper that published in the Journal Emergency Medicine.

The change to ground transport resulted in more 90 percent being treated within national guideline time less 120 minutes, the authors say, versus less half getting treatment within that two-hour window before.

An ST segment elevation myocardial infarction – or STEMI – is usually caused by a total blockage of blood flow to a large portion of the heart, so having this kind of heart need to the blockage cleared as soon as possible.

That procedure, known as angioplasty, isn’t done at all hospitals.

“Across the country about 60 percent of patients with this type of heart present to hospitals that have the capability of doing angioplasty on a 24/7 basis, but only 25 percent of the hospitals have that capability” Mixon said.

When patients show at a hospital that doesn’t offer emergency angioplasty, they need to be transferred to one that does.

The study looked at 43 patients who were initially diagnosed with STEMI at Darnall Community Hospital in Fort Hood, but who needed to be transferred for angioplasty at Scott and White Memorial Hospital in Temple, about 30 miles away.

The authors compared treatment outcomes and transfer times for 19 STEMI patients who were flown between the two hospitals between 2007 and 2010 with 23 patients who were transported by ground ambulance between 2010 and 2012. One more person was transported by air during the period.

None of the patients died during the study. But on average, those who were flown between the hospitals had 123 minutes the time of first medical contact until angioplasty was performed. The patients who were transported by ground ambulance averaged 90 minutes between first medical contact to angioplasty.

This study looked at only one pair of hospitals in Texas, but the need to transfer a with a STEMI to a different facility occurs nationwide, Mixon and his coauthor point out.

“Every hospital is a little different. And 10 miles apart might be prohibitive if you’re in downtown Manhattan – while ten miles apart in a more rural area is not a problem at all,” Mixon said.

“Whether you go by ground or whether you go by air, a lot of would naturally assume that air transport would be quicker, but basically our findings were that while yes, helicopters can fly faster than a truck can drive, it takes a lot longer to a prepared and the helicopter prepared, and that time essentially offsets the speed of transport and ends being slower,” Mixon said.

Dr. Harlan Krumholz cautioned that a small, single-center study like this not be relevant to other places.

Krumholz is director of the Yale-New Haven Hospital Center for Outcomes Research and Evaluation. He was not involved in the study.

“The best thing can do who think they are having a heart attack is call 911 – too many still die before getting emergency care and it is best for not to spend time worrying about which hospital,” he told Reuters Health in an email.

“Ideally the EMS professionals can make an assessment and determine if need to go straight to a hospital with advanced facilities – and whether, if it is not the closest one, whether it is worth the extra time,” he said.