Outcomes of physician-staffed versus non-physician-staffed helicopter transport for ST-elevation myocardial infarction

Background-the effect of physician-staffed helicopter emergency medical service (hems) on st-elevation myocardial infarction (stemi) patient transfer is unknown. the purpose of this study was to evaluate the characteristics and outcomes of physicianstaffed hems (physician-hems) versus non-physician-staffed (standard-hems) in patients with stemi. methods and results-we studied 398 stemi patients transferred by either physician-hems (n=327) or standard-hems (n=71) for primary or rescue percutaneous coronary intervention at 2 hospitals between 2006 and 2014. data were collected from electronic medical records and each institution's contribution to the national cardiovascular data registry. baseline characteristics were similar between groups. median electrocardiogram-to-balloon time was longer for the standard-hems group than for the physician-hems group (118 vs 107 minutes; p=0.002). the standard-hems group was more likely than the physician- hems group to receive nitroglycerin (37% vs 15%; p<0.001) and opioid analgesics (42.3% vs 21.7%; p<0.001) during transport. in-hospital adverse outcomes,including cardiac arrest,cardiogenic shock,and serious arrhythmias,were more common in the standard-hems group (25.4% vs 11.3%; p=0.002). after adjusting for age,sex,killip class,and transport time,patients transferred by standard-hems had increased risk of any serious in-hospital adverse event (odds ratio=2.91; 95% ci=1.39-6.06; p=0.004). in-hospital mortality was not statistically different between the 2 groups (9.9% in the standard-hems group vs 4.9% in the physician-hems group; p=0.104). conclusions-patients with stemi transported by standard-hems had longer transport times,higher rates of nitroglycerin and opioid administration,and higher rates of adjusted in-hospital events. efforts to better understand optimal transport strategies in stemi patients are needed. © 2017 the authors.