Taniguchi Hiroaki, Nagasawa Hiroki, Sakai Tatsuro, Ohsaka Hiromichi, Omori Kazuhiko, Yanagawa Youichi
Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, Shizuoka, Japan.
Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, Shizuoka, Japan.
Air Med J. 2024 Nov-Dec;43(6):544-547. doi: 10.1016/j.amj.2024.09.006. Epub 2024 Oct 8.
Acute aortic dissection (AAD) is a life-threatening condition that necessitates rapid medical intervention. In Japan, helicopter emergency medical services (HEMS) are deployed using either keyword-based early requests or standard requests from ground emergency medical services (GEMS). This study evaluates the impact of these request methods on patient outcomes.
We conducted a retrospective cohort study using data from the Japanese Society for Aeromedical Services registry from April 2015 to March 2020. A total of 342 AAD patients transported by HEMS were analyzed, excluding those with out-of-hospital cardiac arrest. Patients were categorized based on whether HEMS was requested using a keyword method or after initial GEMS contact. We compared the groups on time intervals, prehospital interventions, and outcomes including Cerebral Performance Category.
The time from GEMS awareness to HEMS contact was significantly shorter in the keyword methods group compared with the control group (median 27 vs. 33 minutes, respectively; P < .001). No significant difference was observed in the time from contact to departure from the scene. Patient characteristics, vital signs at HEMS staff contact, and medical interventions provided by HEMS staff showed no statistically significant differences. Changes in vital signs from HEMS staff contact to hospital arrival included a significant decrease in the respiratory rate and systolic blood pressure. Patients in the keyword methods group had a significantly higher proportion of favorable outcomes in terms of Cerebral Performance Category compared with the control group (77.2% vs. 66.5%, P = .03). However, logistic analysis did not show significant differences (odds ratio = 1.007; 95% confidence interval, 0.987-1.016; P = .814).
Keyword methods for early HEMS requests may appear to reduce time to specialty care and suggest improvement of outcomes for patients with AAD.
急性主动脉夹层（AAD）是一种危及生命的疾病，需要迅速的医疗干预。在日本，直升机紧急医疗服务（HEMS）通过基于关键词的早期请求或地面紧急医疗服务（GEMS）的标准请求来部署。本研究评估了这些请求方法对患者结局的影响。
我们使用了日本航空医疗服务协会登记处2015年4月至2020年3月的数据进行回顾性队列研究。分析了总共342例由HEMS转运的AAD患者，排除院外心脏骤停患者。根据HEMS是通过关键词方法请求还是在GEMS首次接触后请求，对患者进行分类。我们比较了两组在时间间隔、院前干预和包括脑功能分类在内的结局方面的情况。
与对照组相比，关键词方法组从GEMS意识到HEMS接触的时间明显更短（中位数分别为27分钟和33分钟；P <.001）。从接触到离开现场的时间没有观察到显著差异。患者特征、HEMS工作人员接触时的生命体征以及HEMS工作人员提供的医疗干预均未显示出统计学上的显著差异。从HEMS工作人员接触到医院到达期间生命体征的变化包括呼吸频率和收缩压显著下降。与对照组相比，关键词方法组在脑功能分类方面的良好结局比例显著更高（77.2%对66.5%，P =.03）。然而，逻辑分析未显示出显著差异（优势比 = 1.007；95%置信区间，0.987 - 1.016；P =.814）。
早期HEMS请求的关键词方法可能似乎减少了获得专科护理的时间，并提示AAD患者的结局有所改善。
