Citations

Background The effect of physician‐staffed helicopter emergency medical service ( HEMS ) on ST ‐elevation myocardial infarction ( STEMI ) patient transfer is unknown. The purpose of this study was to evaluate the characteristics and outcomes of physician‐staffed HEMS (Physician‐ HEMS ) versus non‐physician‐staffed (Standard‐ HEMS ) in patients with STEMI . Methods and Results We studied 398 STEMI patients transferred by either Physician‐ HEMS (n=327) or Standard‐ HEMS (n=71) for primary or rescue percutaneous coronary intervention at 2 hospitals between 2006 and 2014. Data were collected from electronic medical records and each institution's contribution to the National Cardiovascular Data Registry. Baseline characteristics were similar between groups. Median electrocardiogram‐to‐balloon time was longer for the Standard‐ HEMS group than for the Physician‐ HEMS group (118 vs 107 minutes; P =0.002). The Standard‐ HEMS group was more likely than the Physician‐ HEMS group to receive nitroglycerin (37% vs 15%; P <0.001) and opioid analgesics (42.3% vs 21.7%; P <0.001) during transport. In‐hospital adverse outcomes, including cardiac arrest, cardiogenic shock, and serious arrhythmias, were more common in the Standard‐ HEMS group (25.4% vs 11.3%; P =0.002). After adjusting for age, sex, Killip class, and transport time, patients transferred by Standard‐ HEMS had increased risk of any serious in‐hospital adverse event (odds ratio=2.91; 95% CI =1.39–6.06; P =0.004). In‐hospital mortality was not statistically different between the 2 groups (9.9% in the Standard‐ HEMS group vs 4.9% in the Physician‐ HEMS group; P =0.104). Conclusions Patients with STEMI transported by Standard‐ HEMS had longer transport times, higher rates of nitroglycerin and opioid administration, and higher rates of adjusted in‐hospital events. Efforts to better understand optimal transport strategies in STEMI patients are needed.

Abstract A desferrioxamine (DFO) infusion test, using a DFO dose of 36.9±11.2 mg/kg (mean ±SD), was performed in 50 consecutive dialysis patients undergoing diagnostic bone biopsy. In 30 patients whose bones stained positively for aluminium the serum aluminium level increased by an average of 373±250.4 ng/ml. The increase in 20 aluminium-negative patients was 231±179.2 ng/ml (p≪0.05). Aluminium-positive patients had lower levels of immunoreactive parathyroid hormone (336±442 μleq/ml) than aluminium-negative patients (1278±1400 μleq/ml; p≪0.05). A change in serum aluminium level of &gt; 200 ng/ml after the administration of DFO was 73 percent sensitive and 50 percent specific, and had a positive predictive value of 69 percent for detecting positive bone aluminium staining. The combination of a baseline immunoreactive parathyroid hormone level ≪200 leq/ml and a change in serum aluminium of &gt; 200 ng/ml after DFO was 90 percent specific and had a positive predictive value of 85 percent. In the second phase of our study, 28 dialysis patients with aluminium toxicity received longterm therapy (11.0±4.3 months) with DFO at an average starting dose of 41.7±17.1 mg/kg, administered once weekly. The four deaths which occurred during this treatment involved the only patients who had advanced dialysis dementia. Seven patients with less severe neurological symptoms responded favourably. Fractures decreased from 1.7 fractures/patient/year to 0.1 fracture/patient/year. Muscular strength and overall functional class were improved or stable in 25 patients; myalgias and arthralgias were also stable or improved in 19 patients. After 5–7 months of treatment, serum aluminium levels decreased from 401±262 ng/ml to 245±217 ng/ml (p≪0.01); erythrocyte mean corpuscular volume increased from 86.3±10.91 fl to 94.1±9.23 fl (p≪0.02); and serum calcium decreased from 10.4±0.94 mg/dl to 9.9±0.70 mg/dl (p≪0.02). Serum immunoreactive parathyroid hormone levels remained stable in 25 patients, but severe hyperparathyroidism developed rapidly in three patients. Eight patients with transfusional iron overload had no change in serum ferritin levels. Iron depletion developed in six patients, with a decrease in serum ferritin from 251±229.8μg/l to 45±29.3μg/l, and they required parenteral iron supplementation. Significant side-effects occurring during long-term