Helicopter vs. ground transportation of patients bound for primary percutaneous coronary intervention

Abstract

BackgroundImplementation of the first Danish helicopter emergency medical service (HEMS) was associated with reduced time from first medical contact to treatment at a specialized centre for patients with suspected ST elevation myocardial infarction (STEMI). We aimed to investigate effects of HEMS on mortality and labour market affiliation in patients admitted for primary percutaneous coronary intervention (PCI).MethodsIn this prospective observational study, we included patients with suspected STEMI within the region covered by the HEMS from January 1, 2010, to April 30, 2013, transported by either HEMS or ground emergency medical services (GEMS) to the regional PCI centre. The primary outcome was 30‐day mortality.ResultsAmong the 384 HEMS and 1220 GEMS patients, time from diagnostic ECG to PCI centre arrival was lower with HEMS (median 71 min vs. 78 min with GEMS; P = 0.004). Thirty‐day mortality was 5.0% and 6.2%, respectively (adjusted OR = 0.82, 95% CI 0.44–1.51, P = 0.52. Involuntary early retirement rates were 0.62 (HEMS) and 0.94 (GEMS) per 100 PYR (adjusted IRR = 0.68, 0.15–3.23, P = 0.63). The proportion of patients on social transfer payments longer than half of the follow‐up time was 22.1% (HEMS) vs. 21.2% (adjusted OR = 1.10, 0.64–1.90, P = 0.73).ConclusionIn an observational study of patients with suspected STEMI in eastern Denmark, no significant beneficial effect of helicopter transport could be detected on mortality, premature labour market exit or work ability. Only a study with random allocation to one system vs. another, along with a large sample size, will allow determination of superiority of helicopter transport.

Impact of Physician‐staffed Helicopters on Pre‐hospital Patient Outcomes: A systematic review

“…No studies found lower survival in PS‐HEMS (Figure ). Time to hospital was reported to be shorter in PS‐HEMS compared with GEMS in five studies, whereas it was longer in five other studies . Time to hospital was not affected by mode of transportation in two studies (Figure ).…”

“…A beneficial effect on mortality of PS‐HEMS has, however, not been confirmed by Funder et al investigating effect on cardiac and stroke patients reporting OR of 0.82 (0.44‐1.51) and 1.02 (0.53‐1.96) respectively.…”

“…Mortality was reported by two studies in which no difference was found according to type of transportation . Time to hospital was reported in five studies .…”

“…Time to hospital was reported in five studies . Two Danish studies reported a significantly shorter time with PS‐HEMS (84 vs 102 minutes, and 71 vs 78 minutes, both P < .01). The beneficial effect of PS‐HEMS was confirmed by Knudsen et al when distance to hospital exceeded 60 km .…”

“…Six studies had the lowest risk of bias (Newcastle Ottawa Scale 9) . All studies had mortality/survival as primary outcome.…”