Outcomes of Physician‐Staffed Versus Non‐Physician‐Staffed Helicopter Transport for ST‐Elevation Myocardial Infarction

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 physician‐staffed 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.