GRCI 2019 Session PUBMED Does Helicopter Transport Delay Prehospital Transfer For STEMI Patients in Rural Areas? Findings From the CRAC France PCI Registry R.HAKIM , E. Revue, C. Saint Etienne, P. Marcollet, S. Chassaing, MP. Decomis, W. Yafi, C. Laure, S. Gautier, L. Godillon, J. Akkoyun-Farinez, D. Angoulvant, R. Koning, P. Motreff, L. Grammatico- Guillon and G. Rangé CRAC France PCI Registry
DÉCLARATION DE LIENS D'INTÉRÊT AVEC LA PRÉSENTATION Speaker's name : Radwan HAKIM, Le Coudray ☑ Je n'ai pas de lien d'intérêt potentiel à déclarer
Background and aim • Best modalities transfer to PCI (HEMS or GEMS) for STEMI patients in terms of delay is still controversial and no consistent data are available in France • Data from USA and Europe are controversial • Studies have been limited to small series of patients
Methods Largest Prospective, multicenter study published comparing HEMS and GEMS in STEMI Inclusion Exclusion STEMI patients < 12h undergoing PCI Patients undergoing Fibrinolysis Transported by EMS 1 Jan 2014 to 31 Dec 2017 Primary endpoint % of patients with FMC-PPCI < 90 min Secondary endpoints • Overall time from FMC to PPCI • Times according to distance from centres • Times from symptom onset to FMC and to PPCI
CRAC Registry : Centre Val de Loire Region
Flow Chart
Results Proportion of STEMI patients achieving FMC-PPCI guidelines recommendations (≤ 90 min)
Results Secondary endpoint : Median FMC-PPCI delay 140 P=0.2 P< 0.0001 160 P< 0.0001 P< 0.0001 P< 0.0001 P<0,96 120 140 120 100 100 80 80 60 60 40 40 20 20 0 0 Total < 50 km > 50 km Total < 50 km > 50 km HEMS HEMS GEMS N=1370 N=541 GEMS N = 201 N = 1017 ( N= 33 > 75 km) Median FMC-PPCI delay (min) Median FMC-PPCI delay (min) in the overall population in primary transfer
Results Secondary endpoints : Delays according to primary and secondary transfer 250 350 P=0,40 P<0,0001 300 200 250 150 200 P=0,09 P<0,0001 P=0,82 150 100 P=0,28 100 50 50 0 0 Onset-FMC FMC-PPCI Onset-PPCI Onset-FMC FMC-PPCI Onset-PPCI HEMS GEMS HEMS GEMS Median delays in secondary transfer Median delays in primary transfer
Results Total ischemic time P< 0.0001 300 250 + 66 min 200 150 100 50 0 HEMS GEMS
Discussion FMC-PCI centre « flight distance » This clearly benefits the HEMS and gives more strength to our results 8 min (24,5 km)
Discussion Where the helicopter is wasting time? Time consuming steps for HEMS • HEMS activation delay • HEMS platform location > GEMS platform location • Landing zone limitation • Patient boarding and removing Time consuming steps for GEMS • Longer distances by road • Speed limit (80 km/h vs 250 km/h)
Discussion Hourly cost 12000 10.000 euros/h 10000 8000 6000 4000 1500 euros/h 2000 0 HEMS GEMS
Conclusions • In a large French rural area, helicopter transport of STEMI patients was 5 times less likely than ground transport to achieve the 90-minute FMC-PPCI delay • FMC – PPCI delay was significantly prolonged in the HEMS group particularly for transfer distances < 50 km (71% of cases) • More than 1 hour of total ischemic time in the HEMS group compared to the GEMS group In rural areas, GEMS may be considered as the first choice for STEMI patient’s transport to reduce mechanical reperfusion time. HEMS may best be reserved for long transfer distances (≥ 50 km flight distance)
Recommend
More recommend
