Division of Emergency Medicine, Faculty of Medicine, University of Western Ontario, London, Canada.
Prehosp Emerg Care. 2011 Apr-Jun;15(2):240-5. doi: 10.3109/10903127.2010.541978. Epub 2011 Jan 12.
Acute coronary syndrome (ACS) is a spectrum of disease that includes unstable angina (UA), non?ST-segment elevation myocardial infarction (NSTEMI), and ST-segment elevation myocardial infarction (STEMI). Cardiogenic shock is a severe complication of an ACS. Evidence suggests that emergent primary coronary intervention is the treatment of choice for patients with acute STEMI, and patients who have hemodynamic instability or suffer a major complication of therapy also require emergent intervention. These patients may require emergent interfacility transfer for this intervention.
This study examined ACS patient transfers to determine the incidence of adverse events (AEs) during transfer in a large transport medicine service.
This was a retrospective review of prospectively collected data for air medical transfer of ACS or cardiogenic shock patients in Ontario, Canada, from January 2005 to June 2007. Call records and patient care reports were screened for AE identifiers, including resuscitation medication and procedure and unstable cardiac rhythms. Each chart with an AE was independently reviewed by two investigators, with consensus in cases of disagreement, to determine the incidence and type of AE.
During the study period, there were 2,258 transfers for which the patient had a primary diagnosis of ACS or cardiogenic shock. The mean age was 62 years (range 24-91 years), and 68% of the patients were male. Investigators identified one or more AEs that occurred during 127 (5.6%) patient transfers, with hypotension (n = 80), increasing chest pain (n = 52), and arrhythmia (n = 18) as the three most common AEs. There was one death in flight. Management of the AEs was within the scope of practice of transport personnel in all but one case.
The incidence of AEs in air medical transport of ACS patients is low. Air medical crews can safely transport this potentially unstable patient population.
急性冠状动脉综合征（ACS）是一种疾病谱，包括不稳定型心绞痛（UA）、非 ST 段抬高型心肌梗死（NSTEMI）和 ST 段抬高型心肌梗死（STEMI）。心原性休克是 ACS 的严重并发症。有证据表明，对于急性 STEMI 患者，紧急进行原发性冠状动脉介入治疗是首选治疗方法，而那些存在血流动力学不稳定或发生治疗重大并发症的患者也需要紧急介入治疗。这些患者可能需要紧急进行医院间转运以接受这种干预。
本研究调查了 ACS 患者的转运情况，以确定在一个大型转运医学服务中转运过程中不良事件（AE）的发生率。
这是对加拿大安大略省 2005 年 1 月至 2007 年 6 月间进行的 ACS 或心原性休克患者空中医疗转运的前瞻性采集数据进行的回顾性研究。通过呼叫记录和患者护理报告筛选 AE 标识符，包括复苏药物和程序以及不稳定的心脏节律。对于每个有 AE 的病历，均由两名调查员独立进行审查，如果存在分歧，则由两人共同决定，以确定 AE 的发生率和类型。
在研究期间，有 2258 次转运的患者被诊断为 ACS 或心原性休克。平均年龄为 62 岁（范围 24-91 岁），68%的患者为男性。研究人员在 127 次（5.6%）患者转运中发现了一个或多个 AE，其中低血压（n = 80）、胸痛加剧（n = 52）和心律失常（n = 18）是最常见的三种 AE。在飞行过程中有一例死亡。除了一例之外，所有 AE 的处理均在转运人员的实践范围内。
ACS 患者空中医疗转运中 AE 的发生率较低。空中医疗人员可以安全地转运这一潜在不稳定的患者群体。
