Abstract
BackgroundPatients with acute coronary syndrome (ACS) who present to hospitals without interventional facilities frequently require transfer to another hospital equipped with a cardiac catheterization laboratory. This retrospective cohort study evaluates the association of the type of medical transport with patient outcomes.MethodsA retrospective analysis of medical records of patients with ACS transported by basic (BT) and specialist transfer (ST) by emergency medical teams (EMTs). We analyzed age, gender, hemodynamic parameters, type of the emergency medical team, and complications during transport as well as patient survival to hospital admission, survival time and the 30-day mortality rate.ResultsOf 500 patients who underwent transfer, ST transported 368 (73.6%) and BT 132 (26.4%) patients (p < 0.001). Complications during transportation occurred in 3 (1%) in the ST group and 2 (1.5%) in and BT group. Cardiac arrest during transfer occurred in no (0%) patients in the ST group, and 2 (1.5%) in the BT group (p = 0.118). Survival to admission was recorded in all patients in the ST group and 131/132 (0.8%) patients in the BT group (p = 0.592). 40 (12%) of patients in the ST group and 13 (11%) patients in the BT group (p = 0.731) died within 30 days of transfer.ConclusionsComplications during medical transport of ACS patients from hospitals without a cardiac catheter lab to hospitals equipped with such a lab were rare and their incidence was not associated with the type of transporting EMT. The type of EMT was not associated with 30-day patient mortality.
Highlights
Patients with acute coronary syndrome (ACS) who present to hospitals without interventional facilities frequently require transfer to another hospital equipped with a cardiac catheterization laboratory
Considering the differences between paramedics, nurses and doctors as regards education, training, skill level and authority, we hypothesise that paramedics and emergency nurses in the Polish emergency medical system provide safe and effective care of patients, comparable to that provided by physician-led specialist teams during interhospital transfer of ACS patients
Complications during medical transport of ACS patients from non-Percutaneous coronary intervention (PCI) capable hospitals to PCI-capable hospitals in our study were rare and their incidence was not associated with the type of the transporting emergency medical team (EMT)
Summary
Patients with acute coronary syndrome (ACS) who present to hospitals without interventional facilities frequently require transfer to another hospital equipped with a cardiac catheterization laboratory. This retrospective cohort study evaluates the association of the type of medical transport with patient outcomes. For patients presenting with nonSTEMI ACS, guidelines recommend a primary PCI strategy in cases of haemodynamic instability or shock, refractory ischaemic pain, mechanical complications or recurrent dynamic ST-segment or T-wave changes [1]. Given that in Poland the patient has several options regarding how to contact the health care facilities, it is not surprising that such contact is frequently made from outside a hospital equipped with an interventional cardiology (catheterization) unit. In Poland, just over half (56%) STEMI patients are admitted directly to a PCI-capable
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