Delayed door-to-balloon even with helicopters

March 5, 2011 by  
Filed under Acute Med, All Updates, EMS

For a whole bunch of reasons, patients with ST-elevation myocardial infarction who undergo interhospital transfer for primary percutaneous coronary intervention may not meet the required 90 minute door-to-balloon time. In a new study of patients transferred by helicopter, only 3% of STEMI patients transferred for reperfusion met the 90-minute goal. Should this result in an increase in the use of fibrinolysis at non–percutaneous coronary intervention hospitals?

Opportunity for gratuitous helicopter shot never knowingly declined

STUDY OBJECTIVE: Early reperfusion portends better outcomes for ST-segment elevation myocardial infarction (STEMI) patients. This investigation estimates the proportions of STEMI patients transported by a hospital-based helicopter emergency medical services (EMS) system who meet the goals of 90-minute door-to-balloon time for percutaneous coronary intervention or 30-minute door-to-needle time for fibrinolysis.

METHODS: This was a multicenter, retrospective chart review of STEMI patients flown by a hospital-based helicopter service in 2007. Included patients were transferred from an emergency department (ED) to a cardiac catheterization laboratory for primary or rescue percutaneous coronary intervention. Out-of-hospital, ED, and inpatient records were reviewed to determine door-to-balloon time and door-to-needle time. Data were abstracted with a priori definitions and criteria.

RESULTS: There were 179 subjects from 16 referring and 6 receiving hospitals. Mean age was 58 years, 68% were men, and 86% were white. One hundred forty subjects were transferred for primary percutaneous coronary intervention, of whom 29 had no intervention during catheterization. For subjects with intervention, door-to-balloon time exceeded 90 minutes in 107 of 111 cases (97%). Median door-to-balloon time was 131 minutes (interquartile range 114 to 158 minutes). Thirty-nine subjects (21%) received fibrinolytics before transfer, and 19 of 39 (49%) received fibrinolytics within 30 minutes. Median door-to-needle time was 31 minutes (interquartile range 23 to 45 minutes).

CONCLUSION: In this study, STEMI patients presenting to non-percutaneous coronary intervention facilities who are transferred to a percutaneous coronary intervention-capable hospital by helicopter EMS do not commonly receive fibrinolysis and rarely achieve percutaneous coronary intervention within 90 minutes. In similar settings, primary fibrinolysis should be considered while strategies to reduce the time required for subsequent interventional care are explored.

Reperfusion Is Delayed Beyond Guideline Recommendations in Patients Requiring Interhospital Helicopter Transfer for Treatment of ST-segment Elevation Myocardial Infarction.
Ann Emerg Med. 2011 Mar;57(3):213-220

Comments

3 Responses to “Delayed door-to-balloon even with helicopters”

  1. The LITFL Review 009 - Life in the FastLane Medical Blog on March 7th, 2011 02:53

    [...] as always, there’s more to be found on Resus.ME this week, starting with Delayed door-to-balloon even with helicopters — is thrombolysis being underused in the prehospital and remote [...]

  2. Lee Cable on March 15th, 2011 22:04

    There seems to be a flaw in the purpose of this study. Or maybe a lack of clarity. What does method of transport have to do with Dooor to ballon (D2B) time. If the case arrives by horse and buggy or lear jet the time they hit the door to the time of bsllon is no longer influended by the transport medium.
    What are the study authors trying to evaluate? Is it the influence of arrival method? Or the delays from the arrival time at the facility to the balloon?
    Thank you for posting this article I find it interesting although it does leave me with many questions.
    Lee Cable RN, CHRN, CCEMT-P

  3. Steve Soliz, RN, MBA on March 17th, 2011 10:53

    I agree with Lee, this is interesting but the study may reflect a breakdown in the regional transfer protocols versus “helicopter use does not help patients achieve favorable D2B”.