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Can STEMI patients Transferred for Primary PCI Receive Treatment within 90 Minutes in a Rural Setting? C Randolph Hubbard, James C Blankenship, Marie Sledgen,

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Presentation on theme: "Can STEMI patients Transferred for Primary PCI Receive Treatment within 90 Minutes in a Rural Setting? C Randolph Hubbard, James C Blankenship, Marie Sledgen,"— Presentation transcript:

1 Can STEMI patients Transferred for Primary PCI Receive Treatment within 90 Minutes in a Rural Setting? C Randolph Hubbard, James C Blankenship, Marie Sledgen, Kimberly A Skelding, Thomas D Scott, Peter B Berger, Michael A Donegan, G Craig Wood, Frank J Menapace

2 “Heart-Attack-on-a-Plate” “Double Heart Attack Fries” “Crispy Crème Heart Attack”

3 Heart Attack Grill “Home of the Triple Bypass Burger” and “Flatliner Fries” Arizona

4 Background National Registry for Myocardial Infarction --15% of transferred patients had D2B < 120 minutes -- D2B for transferred patients transferred to rural teaching hospital were 73 minutes slower than their urban counterparts Henry et al and Ting et al: D2B for transferred STEMI patients = 95 – 105 minutes

5 Hypothesis A rapid triage/transfer/ treatment protocol can provide primary PCI in less than 90 minutes for STEMI patients presenting to rural community hospitals.

6 Methods Geisinger Medical Center 437-bed tertiary care hospital in rural central PA. Serves 37 counties, 2.4 million people. Lifeflight: 5 helicopters operated by GHS -- Flies for 98% of all requests for transports referring hospitals within 25 minutes flight PCI Program -- 4 interventionists, 1000 PCI/year --GMC provided direct PCI for STEMI since of 4 docs lives within 7 minutes

7 Methods January 1, 2005: Level 1 Heart Attack program started -- One call dispatches helicopter -- GMC ED doc pages PCI doc who calls lab staff -- Lab staff meets patient at the helipad doors

8 Database started July 1, 2004 with data to 1/1/04 Prospectively recorded milestones -Presentation to the community hospital -EKG time -Helicopter Dispatch -Helicopter arrival and departure -Arrival at GMC, arrival at Cath Lab -Wire crossing, device activation Visits and protocols to referring hospitals

9

10 Blue = 30 miles- 15 min flight time (each way) Red= 60 miles- 23 min flight time (each way)

11 Jan Level 1 Nurse Coordinator hired Report cards developed and distributed Quarterly meetings for all members of network

12 Jan ED doc directly activates cath lab Group page broadcast simultaneously

13 Results Patients Presenting Directly to GMC 2004 (n = 36) 2005 (n = 33) 2006 (n = 61) 2007 (n = 34) D2B (Minutes)

14 Results Patients Transferred to GMC 2004 (n = 110) 2005 (n = 134) 2006 (n = 143) 2007 (n = 63) D2B (Minutes)

15 Results Patients Transferred to GMC HospitalD2BFlight Time D2B – Flight Time A83677 B83677 C85778 D E Others105--

16 Results Jan – March 2007 % transferred patients with D2B < 90: 52% % transferred patients with D2B < 120: 74 %

17 Conclusions D2B < 120 minutes can be frequently achieved D2B < 90 minutes can be frequently achieved by some referring hospitals

18 Limitations GMC experience may not be generalizeable -- GMC owns helicopter service -- Closed cath lab -- Interventionists live close by Used door-to-wire until 2007 Presentation times hard to ascertain from records

19 Future Improvements Pre-hospital 12 lead EKGs

20 One Seamless Network for Pennsylvania


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