Cardiac patient air medical transport in the northeast region of the United States.

OBJECTIVES: 1) To develop and analyze a database of cardiac patient demographics and transport variables in the northeast region of the United States, and 2) to develop skills to enable future collaborative research in this region. METHOD: A retrospective review of air transport medical records was performed by flight crew members from five independent air medical transport programs. Parameters describing age, gender, cardiac diagnosis, referral patterns, hemodynamic parameters, medication infusions, arrhythmias, and invasive procedures were included. RESULTS: Data for 1,320 cardiac patients over the age of 30 years were compiled. Seventy percent were male, 30% were female, and the mean age was 60.7 years. The median flight time was 13 minutes. Seventy-three percent had a referring agency diagnosis of acute myocardial infarction. Transport originated from an emergency department 49% of the time and from an intensive care unit 51% of the time. Twenty percent of the patients had a heart rhythm other than normal sinus rhythm during transport. Twenty-eight patients had ventricular arrhythmias in flight (2%) and 28 patients suffered cardiac arrests (2%). Cardiogenic shock was observed in 13% of the patients. Twenty percent of the patients were endotracheally intubated. CONCLUSIONS: A database of patients transported by air for cardiac diagnoses was successfully established. Acute myocardial ischemia was the major indication for air transport. A region of flight programs collaborating on a research project can generate a large pool of subjects for analysis. Limitations of the methodology were identified and future research goals were better defined.

Helicopter transport of the patient receiving thrombolytic therapy.

Since thrombolytic therapy with t-PA is now available for use in all hospitals, the need for air transport of patients with acute MI for enrollment in clinical trials has decreased. However, air transport will continue to be used for the thrombolytic therapy candidate requiring further intervention. This patient population will most likely include those with large areas of myocardium at risk, those who failed to reperfuse, or those with symptoms of reocclusion. Transfer to tertiary care centers for coronary angiography, PTCA, and aortocoronary artery bypass will no doubt contribute further to the need to transport the patient with acute MI receiving thrombolytic therapy. The New England Life Flight experience and that of others have documented the safety and feasibility of air transport of the thrombolytic therapy recipient.