Department of Emergency Medicine, University of Massachusetts Medical School, Worcester, Massachusetts 01655, USA.
Prehosp Emerg Care. 2010 Apr-Jun;14(2):159-63. doi: 10.3109/10903120903537221.
Standard of care for patients with acute coronary syndrome/ST-segment elevation myocardial infarction (ACS/STEMI) is rapid revascularization of ischemic myocardium. Current optimal treatment is primary percutaneous coronary intervention (PCI) within 90 minutes after the patient accesses the health care system, and strategies to lower this time may improve outcomes.
To compare interhospital transport times (TTs) before and after instituting a no-medication-infusion policy during transport of ACS patients. Our hypothesis was that transporting patients using only bolus medications would significantly reduce transport times without increasing hospital length of stay (LOS) or increasing mortality.
We conducted an institutional review board (IRB)-approved retrospective chart review of all patients transferred from an outlying hospital to a primary PCI center using either critical care helicopter or ground transport. The study period was January 2006 through January 2008, with the policy of discontinuing infusions instituted in April 2007. The TT was calculated using departure and arrival times from dispatch logs. The LOS was determined via electronic medical record review. The TT and LOS differences were calculated using two-tailed t-tests with Welch's correction where appropriate. Results. A total of 154 ACS/STEMI transports were completed during the study period (74 before and 80 after policy initiation). The mean (+/- standard error of the mean) TT was 43.5 +/- 1.2 minutes before the policy and 37.1 +/- 0.9 minutes after the policy (p < 0.01). To specifically address different transport distances, we analyzed TTs from an identical group of referral hospitals in both the before- and after-policy groups. A significant reduction in TT remained in this after-policy group (TTs 43.5 +/- 1.2 minutes before the policy and 37.1 +/- 0.9 minutes after; p = 0.01). Data on LOS were available for 127 patients (58 patients before and 69 patients after) and averaged 4.6 +/- 0.8 days prior to the new policy and 3.9 +/- 0.4 days after (p = 0.41). Overall, only one patient died (after-policy group) (p = not significant).
A policy of transferring patients from one hospital directly to a cardiac catheterization laboratory using only bolus medications significantly reduces total door-to-needle time without adverse effects on LOS or mortality. Other institutions may want to consider such policies for interfacility transport of ACS patients.
急性冠脉综合征/ST 段抬高型心肌梗死（ACS/STEMI）患者的标准治疗方法是迅速使缺血心肌再灌注。目前的最佳治疗方法是在患者进入医疗系统后 90 分钟内进行经皮冠状动脉介入治疗（PCI），而降低这一时间的策略可能会改善预后。
比较急性冠脉综合征患者在转运过程中实施无药物输注政策前后的院内转运时间（TT）。我们的假设是，仅使用推注药物转运患者可显著缩短转运时间，而不会增加住院时间（LOS）或增加死亡率。
我们对通过重症监护直升机或地面转运从外院转至初级 PCI 中心的所有患者进行了机构审查委员会（IRB）批准的回顾性图表审查。研究期间为 2006 年 1 月至 2008 年 1 月，2007 年 4 月停止输注药物。TT 是通过调度日志的出发和到达时间计算得出的。通过电子病历审查确定 LOS。使用双尾 t 检验和 Welch 校正（如果需要）计算 TT 和 LOS 差异。结果。研究期间共完成了 154 例 ACS/STEMI 转运（政策实施前 74 例，后 80 例）。在政策实施前，平均（+/- 标准误差）TT 为 43.5 +/- 1.2 分钟，在政策实施后为 37.1 +/- 0.9 分钟（p < 0.01）。为了专门分析不同的转运距离，我们在政策实施前后的同一组转诊医院中分析了 TT。在该政策实施后的组中，TT 仍显著降低（TTs 为 43.5 +/- 1.2 分钟，政策实施后为 37.1 +/- 0.9 分钟；p = 0.01）。127 例患者（58 例在前，69 例在后）的 LOS 数据可用，平均分别为新政策前 4.6 +/- 0.8 天和新政策后 3.9 +/- 0.4 天（p = 0.41）。总体而言，只有 1 例患者死亡（后政策组）（p = 无统计学意义）。
从一家医院直接将患者转运至导管室，仅使用推注药物，可显著缩短总门到针时间，而不会对 LOS 或死亡率产生不利影响。其他机构可能希望考虑为 ACS 患者的院际转运制定此类政策。
