Early aeromedical transfer after acute coronary syndromes

To investigate the safety and efficacy of early aeromedical transfer after acute coronary syndromes (ACS). The Island of Jersey is 160 km from the UK and as no catheter laboratory facilities exist locally, patients with ACS are transferred to tertiary centres by air ambulance in the UK for further investigations.

All patients transferred to the UK for investigation after ACS in 2008 were identified retrospectively from coronary care admission records and the local flight transfer database. Data were collected on patient demographics, diagnosis, time from presentation, flight duration, accompanying personnel and in-flight complications. Significant complications were defined as death, cardiac or respiratory arrest, sustained arrhythmia requiring electrical cardioversion or the need for endotracheal intubation.

65 patients (mean age 61.7 years; 80.0% male) were transferred for cardiac catheterisation after non-ST elevation myocardial infarction (n=30, 46.2%) or ST elevation myocardial infarction (n=23, 35.4%), or with unstable angina (n=12, 18.5%). Patients were transferred 3.6 ± 3.4 days after presentation; mean transfer time was 171.6 ± 38.8 min. The majority (90.8%) of patients were transferred with both a doctor and a nurse. There were no significant complications during transfer. Intra-transport medication with nitrates, diuretics, analgesia, antiemetics or antiarrhythmics was required in 15 (23.1%) patients.

Aeromedical transfer after ACS is safe within 3 days of presentation. Given the minor nature of in-flight complications, a paramedic and coronary care nurse are sufficient medical escort for these patients.