Safety of interhospital transport of patients with acute myocardial infarction

Abstract

Objectives: To describe the rate of complications in patients who undergo interhospital transport in the early stages of acute myocardial infarction and to determine whether instability in the emergency department is a predictor of these complications. Methods: A retrospective medical record review of patients with proven acute myocardial infarction transferred from Wyong Emergency Department to Gosford Hospital in the period 1994–96 was performed. Results: Three hundred and twenty‐three patients were transported. Four patients required an unplanned intervention; all four patients suffered hypotension and all had an intravenous nitroglycerin infusion. Three patients required fluid resuscitation and one patient developed supraventricular tachycardia with hypotension, treated by cardioversion. No other complications, cardiac arrest or deaths were recorded. Prior patient instability did not predict three out of four complications during transfer and did not predict any complications in non‐intubated patients. Conclusion: Medical escort of stabilized non‐intubated patients in the early stages of acute myocardial infarction is probably unnecessary. Further prospective studies are needed to determine which patients with acute myocardial infarction can be safely transported without a medical escort.

Safety of interhospital transport of cardiac patients and the need for medical escorts

“…This might be a reflection of the patient population or stabilization of patients by the retrieval team prior to take‐off. Compared with a New South Wales study, 1 there was a higher rate of complications in AMI patients transferred (21% vs 1.2%). This might reflect the criteria used to assess complications in the patients in the present study.…”

“…7 More recently and locally, a study of AMI patients again confirmed safety and concluded that medical escorts were probably unnecessary unless the patient was intubated or unstable (defined as ongoing pain, dysrhythmia, pump failure or symptomatic hypotension) prior to transport. 1 However, the study also noted that prior instability did not necessarily predict complications during transport.…”

“…Earlier studies established that transferring unstable angina pectoris/valvular/CCF patients by road 5 or helicopter 6 over similar travel times and distances was safe, and escorts mainly comprised paramedics, 5 nurses 6 or doctor/registered nurse 7 . More recently and locally, a study of AMI patients again confirmed safety and concluded that medical escorts were probably unnecessary unless the patient was intubated or unstable (defined as ongoing pain, dysrhythmia, pump failure or symptomatic hypotension) prior to transport 1 . However, the study also noted that prior instability did not necessarily predict complications during transport.…”

“…This often necessitates their transfer from referring hospitals to those offering cardiac services, often before definitive diagnosis and while acutely unwell. Although it seems that the safety of transporting cardiac patients has been established 1,2 , rational decision making in the choice of escorts for these transports has been limited by the lack of available evidence 3 . Those studies that have been performed often rely on discharge diagnoses, and this limits the applicability of results to clinical practice.…”