Does Helicopter Transport Delay Prehospital Transfer For STEMI - - PowerPoint PPT Presentation

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

GRCI 2019 Session PUBMED

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
• f 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

Inclusion STEMI patients < 12h undergoing PCI Transported by EMS 1 Jan 2014 to 31 Dec 2017 Largest Prospective, multicenter study published comparing HEMS and GEMS in STEMI Exclusion Patients undergoing Fibrinolysis 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)

20 40 60 80 100 120 140 160

Total < 50 km > 50 km HEMS GEMS

P< 0.0001 P< 0.0001

N=1370 N=541

20 40 60 80 100 120 140

Total < 50 km > 50 km HEMS GEMS

N = 1017 N = 201 ( N= 33 > 75 km)

P< 0.0001 P< 0.0001 P=0.2

Median FMC-PPCI delay (min) in the overall population Median FMC-PPCI delay (min) in primary transfer Secondary endpoint : Median FMC-PPCI delay

Results

P<0,96

Median delays in primary transfer

Median delays in secondary transfer

Secondary endpoints : Delays according to primary and secondary transfer

Results

50 100 150 200 250 Onset-FMC FMC-PPCI Onset-PPCI HEMS GEMS

P=0,28 P<0,0001 P<0,0001

50 100 150 200 250 300 350 Onset-FMC FMC-PPCI Onset-PPCI HEMS GEMS

P=0,82 P=0,09 P=0,40

Total ischemic time

Results

50 100 150 200 250 300

HEMS GEMS

+ 66 min

P< 0.0001

8 min (24,5 km)

Discussion

FMC-PCI centre « flight distance » This clearly benefits the HEMS and gives more strength to our results

Where the helicopter is wasting time?

Discussion

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)

2000 4000 6000 8000 10000 12000 HEMS GEMS

10.000 euros/h 1500 euros/h

Hourly cost

Discussion

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)