Internal Medicine PGY3 McMaster University Hamilton, Ontario, Canada
Background: Patients presenting from the field via emergency medical services with ST-elevation myocardial infarction (STEMI) are redirected to hospitals capable of percutaneous coronary intervention (PCI). After initial treatment of the STEMI, patients are frequently repatriated to their local peripheral hospital for further observation and management. Nurses often accompany the patient during repatriation, which can transiently lead to short-staffing of the cardiac care unit (CCU) and increase resource utilization costs. This study aimed to evaluate the incidence of adverse events during the early transfer of STEMI patients following revascularization from a PCI-capable centre to peripheral hospitals.
METHODS AND RESULTS: We prospectively collected data on consecutive patients being transfered within 24 hours following a STEMI from the Hamilton General Hospital (Hamilton, Ontario) to a peripheral hospital who were accompanied by a nurse between December 11, 2020 and January 1, 2024. The accompanying nurses completed a one-page standardized form to document adverse events and interventions. We then assessed the CCU admission ledgers to identify patients who were not prospectively captured for retrospective chart review. The primary outcome was the incidence of adverse events.
Of 398 prospectively identified patients who underwent repatriation, 340 met inclusion criteria and were analyzed. The mean age was 64 years, 25% were females, and 41% suffered an anterior STEMI. There were 6 patients who had documented clinically significant events with an incidence of 1.8% (95%CI 0.4%–3.2%). There was 1 occurrence of ventricular tachycardia/fibrillation, 2 occurrences of hypotension, and 4 occurrences of chest pain. One patient had both hypotension and chest pain. Four events required a nursing intervention: 1 event required CPR/defibrillation, 1 event required vasopressor administration, and 2 events required diversion to the nearest emergency department. All patients who experienced ventricular tachycardia/fibrillation or hypotension, or required nursing intervention, had experienced an anterior STEMI. The median nursing time away from the CCU was 120 minutes (IQR [90, 150], n=323). Of the 525 retrospectively assessed CCU admission ledgers, only 37 charts included notes about repatriation. No clinically significant events were identified for any of these retrospectively identified patients.
Conclusion: Serious adverse events during early repatriation are rare but occur frequently enough to warrant a nursing escort. All adverse events requiring nursing intervention occurred in patients who experienced an anterior STEMI. These findings may influence protocols for repatriation, inform CCU staffing and resource utilization.
