Ganter Julian, Busch Hans-Jörg, Henis Alina, Reifferscheid Florian, Braun Jörg, Heinrich Sebastian
Department of Anesthesiology and Critical Care, Faculty of Medicine, Medical Center - University of Freiburg, University of Freiburg, Hugstetter Str. 55, 79106, Freiburg, Germany.
German Air Rescue Service Association DRF Luftrettung, Rita-Maiburg-Str. 2, 70794, Filderstadt, Germany.
BMC Emerg Med. 2025 Aug 2;25(1):145. doi: 10.1186/s12873-025-01308-7.
Acute coronary syndromes (ACS) are a leading cause of helicopter emergency medical services (HEMS) operations in Germany. Complications that arise during HEMS operations are challenging due to limited resources. However, the National Advisory Committee for Aeronautics (NACA) score and National Early Warning Score (NEWS) provide potential for risk stratification. Nevertheless, there is an absence of data concerning the incidence and risk of medical events (e.g. malignant arrhythmia, cardiac arrest, cardiogenic shock) in ACS patients during HEMS operations. The objective of this study is to evaluate the incidence of medical events and to assess risk stratification using scoring systems.
This retrospective observational cohort study analyzed prehospital records from 38,473 HEMS operations with "ACS" coding conducted between 2012 and 2024 in Germany. Routine data were systematically recorded using a standardized digital form that captured patient demographics, clinical presentation, and medical interventions. Major medical events (MME) were defined using surrogate markers, including defibrillation, resuscitation, airway management, ventilation, and new ST-elevation myocardial infarction (STEMI) findings. Scores (NACA, NEWS, and a combined MME-score) were calculated, with the MME-score integrating NACA and NEWS. Ethical approval was obtained from the Albert-Ludwigs-University Freiburg Ethics Committee (No: 24-1082-S1, 25 April 2024).
MME occurred in 8.8% of the 38,473 HEMS operations. They occurred more frequently during secondary missions (interfacility transports) (11.8%) than primary missions (6.7%), and at night (15.3%) than during the day (8.2%) (both p < 0.001). The NACA, NEWS, and MME-scores were significantly higher in cases with medical events (p < 0.001). The risk stratification exhibited areas under the curve in the receiver operating characteristics (ROC) curve, with values of 0.831 for NACA, 0.866 for NEWS, and 0.895 for the MME-score.
The incidence of MMEs is subject to variation depending on the operational context. Established scoring systems such as the NACA and NEWS are available for the purpose of risk stratification of medical events in patients with ACS during air rescue operations. The combination of these scores may indicate potential for improved risk stratification.
急性冠状动脉综合征（ACS）是德国直升机紧急医疗服务（HEMS）行动的主要原因。由于资源有限，HEMS行动期间出现的并发症具有挑战性。然而，美国国家航空咨询委员会（NACA）评分和国家早期预警评分（NEWS）提供了风险分层的可能性。尽管如此，目前缺乏关于ACS患者在HEMS行动期间医疗事件（如恶性心律失常、心脏骤停、心源性休克）发生率和风险的数据。本研究的目的是评估医疗事件的发生率，并使用评分系统评估风险分层。
这项回顾性观察队列研究分析了2012年至2024年期间在德国进行的38473次编码为“ACS”的HEMS行动的院前记录。使用标准化数字表格系统记录常规数据，该表格记录了患者的人口统计学信息、临床表现和医疗干预措施。主要医疗事件（MME）使用替代指标定义，包括除颤、复苏、气道管理、通气和新的ST段抬高型心肌梗死（STEMI）发现。计算了评分（NACA、NEWS和综合MME评分），其中MME评分整合了NACA和NEWS。获得了弗莱堡阿尔伯特 - 路德维希大学伦理委员会的伦理批准（编号：24 - 1082 - S1，2024年4月25日）。
在38473次HEMS行动中，8.8%发生了MME。它们在二级任务（机构间转运）中（11.8%）比一级任务（6.7%）更频繁发生，在夜间（15.3%）比白天（8.2%）更频繁发生（两者p < 0.001）。发生医疗事件的病例中，NACA、NEWS和MME评分显著更高（p < 0.001）。风险分层在受试者工作特征（ROC）曲线下呈现出面积，NACA为0.831，NEWS为0.866，MME评分为0.895。
MME的发生率因操作背景而异。诸如NACA和NEWS等既定评分系统可用于在航空救援行动中对ACS患者的医疗事件进行风险分层。这些评分的组合可能表明有改善风险分层的潜力。
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