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Clinical adverse events in prehospital patients with ST-elevation myocardial infarction transported to a percutaneous coronary intervention centre by basic life support paramedics in a rural region

  • Sylvain Bussières (a1), François Bégin (a1), Pierre-Alexandre Leblanc (a1), Alain Tanguay (a1), Jean-Michel Paradis (a2), Denise Hébert (a1) and Richard Fleet (a1)...

Abstract

Objectives

It remains unclear whether ST-elevation myocardial infarction (STEMI) patients transported by ambulance over long distances are at risk for clinical adverse events. We sought to determine the frequency of clinical adverse events in a rural population of STEMI patients and to evaluate the impact of transport time on the occurrence of these events in the presence of basic life support paramedics.

Methods

We performed a health records review of 880 consecutive STEMI patients transported to a percutaneous coronary intervention centre. Patients had continuous electrocardiogram and vital sign monitoring during transport. A classification of clinically important and minor adverse events was established based on a literature search and expert consensus. A multivariate ordinal logistic regression model was used to study the association between transport time (0-14, 15-29, ≥30 minutes) and the occurrence of overall clinical adverse events.

Results

Clinically important and minor events were experienced by 18.5% and 12.2% of STEMI patients, respectively. The most frequent clinically important events observed were severe hypotension (6.1%) and ventricular tachycardia/ventricular fibrillation (5.1%). Transport time was not associated with a higher risk of experiencing clinical adverse events (p=0.19), but advanced age was associated with adverse events (p=0.03). No deaths were recorded during prehospital transport.

Conclusions

In our study of rural STEMI patients, clinical adverse events were common (30.7%). However, transport time was not associated with the occurrence of adverse clinical events in these patients.

Objectifs

Il demeure incertain si les patients ayant subi un infarctus du myocarde avec sus-décalage du segment ST (STEMI : acronyme anglais) et transportés en ambulance sur une longue distance sont susceptibles de subir des événements cliniques indésirables. L’étude visait donc à déterminer la fréquence des événements cliniques indésirables chez des patients ayant subi un STEMI et vivant en milieu rural, et à évaluer l’incidence de la durée du transport effectué par des ambulanciers paramédicaux en soins primaires sur la survenue de ces événements.

Méthode

Nous avons procédé à un examen des dossiers médicaux de 880 patients consécutifs ayant subi un STEMI et transportés dans un centre spécialisé en vue d’une intervention coronarienne percutanée (ICP). Les patients étaient soumis à une surveillance électrocardiographique continue et des signes vitaux durant le transport. Nous avons établi une classification d’événements cliniques indésirables, graves et bénins, fondée sur une recherche documentaire et sur l’avis consensuel d’experts. Un modèle de régression logistique ordinal multivarié a servi à étudier l’association entre la durée de transport (0-14, 15-29, ≥30 min) et la survenue, dans l’ensemble, des événements cliniques indésirables.

Résultats

Des événements cliniques indésirables, graves et bénins, ont été enregistrés chez 18,5% et 12,2% des patients ayant subi un STEMI, respectivement. Les événements cliniques importants observés les plus fréquents étaient une hypotension grave (6,1%) et de tachycardie ventriculaire/fibrillation ventriculaire (5,1%). Il n’y avait pas d’association entre la durée de transport et l'augmentation du risque de subir des événements indésirables (p=0,19), mais l’âge avancé était associé à des événements indésirables (p=0,03). Aucun patient n’est décédé durant le transport préhospitalier.

Conclusions

Dans notre étude de patients ayant subi un STEMI en milieu rural, les événements cliniques indésirables étaient fréquents (30,7%). Toutefois, la durée de transport n’était pas associée à la survenue de ces complications.

Copyright

Corresponding author

*Correspondence to: Dr. Richard Fleet, Chaire de recherche en médecine d’urgence Université Laval-CHAU Hôtel Dieu de Lévis, 143 Rue Wolfe, Lévis, Québec, QC G6V 3Z1, Canada; Email: rfleet@videotron.ca

References

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