Abstract 2074: Treatment and Transport Limitations Associated with Inter-Hospital Transfer Strategies for ST Elevation Myocardial Infarction: One Shoe Does Not Fit All
Background: The applicability of a universal algorithm for inter-hospital transport of ST elevation myocardial infarction (STEMI) patients for primary percutaneous coronary intervation (PPCI) is limited by the availability of healthcare resources and delays in process of care.
Methods: We examined the applicability of a triage and transfer algorithm established to facilitate inter-hospital transfer from 6 community hospitals (CH) to 2 PPCI-capable tertiary centers in rural central Illinois. This CH emergency room (ED)-driven algorithm included an IV fibrinolytic (FIB) arm used in the event of anticipated transport delays. Eight time intervals were examined to localize delays in the process of STEMI care.
Results: Between 2/2005 and 5/2006, 119 presumed STEMI patients were transported by helicopter (n= 83; 70%) or ground ambulance (n= 36; 30%) 40 +/− 14 miles (a range: 28 – 66 miles). CH-ED STEMI was misdiagnosed in 18 (15.1%) patients. Of the 101 STEMI patients, 8 (6.7%) received FIB and 93 (78.2%) were transferred for PPCI. Door-to-TIMI 3 perfusion ≤ 120 minutes as achieved in 58% of PPCI-treated patients.
Conclusion: In this structured inter-hospital transfer algorithm, timely PPCI was achievable in a significant proportion of STEMI patients transferred from CH. Due to unavailability of rapid transport FIB use is still required in approximately 7% of patients but is avoidable in up to 15% of patients with misdiagnoses. The greatest impediment to rapid inter-hospital transfer for STEMI occurs at the CH-ED, largely attributable to delay awaiting transportation arrival.