Early inter-hospital transfer of patients with myocardial infarction without a doctor, paramedic or nurse on board: results from a French regional emergency care network

Abstract

Background: In France, patients with acute coronary syndromes (ACS) are usually transferred from remote hospitals to percutaneous coronary intervention (PCI) centres in mobile intensive care units (MICUs) with on-board medical staff. They are then returned to the remote hospitals by MICU 48 h after PCI. However, MICU transportation and beds in a PCI centre are in short supply. Therefore, we investigated clinical outcomes among intermediate-risk ACS patients who were transferred in private ambulances without an on-board medic or paramedic; and returned to the remote hospital sooner after PCI.

Methods: In the French Alps, the RESURCOR network manages 'SCA-Alp' transfers using strict management protocols in ambulances with trained drivers and automatic external defibrillators, but without heart rhythm monitoring. We conducted an observational retrospective study that assessed outcomes (death and emergency return to the PCI centre within 48 h) in patients transferred using SCA-Alp. Our population comprised stabilized patients with ST-segment elevation myocardial infarction (STEMI) who returned to the remote hospital within 24-48 h of PCI, and uncomplicated patients with non-ST-segment elevation myocardial infarction (NSTEMI) within 24-72 h of symptom onset who come from and returned to ('round-trip') the remote hospital on the day of PCI (return < 12 h after PCI).

Results: Between 2010 and 2014, 101 STEMI and 490 NSTEMI patients were transferred using SCA-Alp. No adverse events occurred during transportation and no deaths were reported. Two of 591 patients (0.3% [95% confidence interval 0.1-1.4%]) experienced a stent thrombosis within 48 h of PCI that required a second urgent PCI; both were event free at 6-month follow-up.

Conclusions: Inter-hospital transfer using SCA-Alp is associated with low event rates in intermediate-risk ACS patients, allowing a more streamlined use of medical facilities and freeing-up of beds in PCI centres.

Keywords: France; Myocardial infarction; Percutaneous coronary intervention; SCA-Alp protocol; Transfer.

Fig. 1

The Haute-Savoie hospital network. ICU, intensive care unit; PCI, percutaneous coronary intervention

Fig. 2

Organization of transfers between remote hospitals and the PCI centre. ED: emergency department; ICU: intensive care unit; MICU: mobile intensive care unit; NSTEMI: non-ST-segment elevation myocardial infarction; PCI: percutaneous coronary intervention; STEMI: ST-segment elevation myocardial infarction. *Only NSTEMI patients who had been stable for ≥24 h in the remote centre were eligible for SCA-Alp transfer to the PCI centre; only NSTEMI patients with optimal PCI results were eligible for SCA-Alp transfer back to the remote hospital (within 12 h of PCI). †Only STEMI patients with an optimal revascularization procedure and no recurrence of angina, acute cardiac failure, or significant ventricular arrhythmias in the 24 h following admission were eligible for SCA-Alp transfer back to the remote hospital (24–48 h after PCI)

Fig. 3

Flow charts of patients with a STEMI and b NSTEMI. ED: emergency department; NSTEMI: non-ST-segment elevation myocardial infarction; STEMI: ST-segment elevation myocardial infarction