HEMS vs. EMS transfer for acute aortic dissection type A.
Air Medical Journal · 2009-01-01 · Observational study
Abstract
BACKGROUND: We thought to evaluate the impact of the mode of physician-based transportation (helicopter emergency medical service [HEMS] vs. ground-based emergency medical service [EMS]) on short- and long-term survival among patients suffering acute aortic dissection type A (AADA) as a primary end-point. METHODS: One-hundred-seventy-seven AADA patients (59 +/- 13 years) were included who were admitted to a cardiothoracic surgery department with comprehensive transfer documentation. Cox proportional hazard models and log-rank tests were performed as well as Kaplan-Meier survival curves. Follow-up was 93% over 5 +/- 2(3/4) years. RESULTS: Cox proportional hazard model found no mortality difference for HEMS versus EMS on primary transport (P = .5), as well as log-rank (Mantel Cox) on interhospital transport (P = 0.5). HEMS interhospital transfer was eightfold more expensive than EMS (HEMS, 3,871; EMS, 497; P = .01). Ninety-nine patients (56%) were alive at follow-up (mean survival, 1,153 days +/- 1,124). Mortality after surgery was 2% (3/177) within the first hour, 5% (8/177) within 6 hours, 6% (10/177) within 12 hours, 11% (20/177) within 24 hours, 13% (23/177) within 48 hours, 14% (25/177) within 72 hours, and 26% (46/177) within 30 days after surgery. CONCLUSIONS: We found no advantage of survival rates among patients suffering from AADA who were transferred by either HEMS or EMS in primary or secondary transport. Although HEMS traveled a distance more than twofold longer than ground-based EMS at the same mission time, HEMS was eightfold more expensive than ground-based EMS in AADA.
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Tags
Helicopter & air ambulance · Cost & cost-effectiveness · Interfacility & critical care transport · Mortality & survival
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