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Search and rescue helicopter-assisted transfer of ST-elevation myocardial infarction patients from an island in the Baltic Sea: results from over 100 rescue missions
  1. Mikkel Malby Schoos1,
  2. Henning Kelbæk1,
  3. Frants Pedersen1,
  4. Benedict Kjærgaard2,
  5. Sven Trautner3,
  6. Lene Holmvang1,
  7. Erik Jørgensen1,
  8. Steffen Helqvist1,
  9. Kari Saunamäki1,
  10. Thomas Engstrøm1,
  11. Peter Clemmensen1
  1. 1Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
  2. 2Department of Cardiothoracic Surgery, Aalborg University Hospital, Denmark and Medical Lead for the Royal Danish Air Force's Sea Air Rescue, Copenhagen, Denmark
  3. 3Falck A/S—Danish-based global Provider of Emergency Medical Services & Flight Surgeon RDAF SAR sqn, Copenhagen, Denmark
  1. Correspondence to Dr Mikkel Malby Schoos, Department of Cardiology, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, Copenhagen 2100, Denmark; mikkel.schoos{at}gmail.com

Abstract

Background Since 2005, ST-elevation myocardial infarction (STEMI) patients from the island of Bornholm in the Baltic Sea have been transferred for primary percutaneous coronary intervention (pPCI) by an airborne service. We describe the result of pPCI as part of the Danish national reperfusion strategy offered to a remote island population.

Methods In this observational study, patients from Bornholm (n=101) were compared with patients from the mainland (Zealand) (n=2495), who were grouped according to time intervals (<120, 121–180, >180 min). The primary endpoint was all-cause 30-day mortality. Individual-level data from the Central Population Registry provided outcome that was linked to our inhospital PCI database.

Results Treatment delay was longer in patients from Bornholm (349 min (IQR 267–446)) vs Zealand (211 (IQR 150–315)) (p<0.001). In patients from Zealand, 30-day mortality did not increase with time intervals (p=0.176), whereas, long-term mortality did (∼3 years) (p=0.007). Thirty-day mortality was similar for Bornholm and the overall Zealand group (5.9% vs 6.2% p=0.955). Early presenters (<180 min) from Zealand (37%) had similar 30-day (5.3% vs 5.9% p=0.789), but numerically reduced long-term mortality compared with Bornholm (12.8% vs 15.8% p=0.387). Age, female gender, diabetes, Killipclass >2 and preprocedural thrombolysis in myocardial infarction (TIMI) flow 0/1 independently predicted 30-day mortality, however, treatment delay did not. Postprocedural TIMI flow 3 predicted improved survival.

Conclusions In this small population of STEMI patients from a remote island, airborne transfer appears feasible and safe, and their 30-day mortality after pPCI comparable with that of the mainland population despite inherent reperfusion delay exceeding guidelines.

  • acute myocardial infarct
  • remote and rural medicine
  • helicopter retrieval
  • prehospital care
  • cardiac care, thrombolysis

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