Air transport benefits only some patients

Air transport of hospital patients is expensive, but little real research has been done to prove that it actually benefits patients. Now a new study of patients who have suffered cardiac arrest suggests that air transport is only useful in some instances.

Researchers analyzed the medical records of 157 cardiac-arrest patients flown primarily from rural hospitals in Ohio to specialty hospitals in Columbus.

They found that nearly half -- 45 percent -- of the patients whose underlying cardiovascular disease caused their attack survived, while those whose cardiac arrest resulted from a noncardiovascular cause -- such as an electrocution injury or disease of another organ system -- had only a 14 percent survival rate.

By Jo McCulty

Howard Werman studies the need for emergency air transport.

"There is a subset of patients who do well when transported by air, especially those suffering from a cardiac event that stems from cardiovascular disease," said Howard Werman, a clinical associate professor of emergency medicine.

The causes of cardiac arrest in this study included underlying cardiovascular disease (69 patients); nonheart-related medical causes such as lung or kidney disease or an infection (27); near-drowning (40); suffocation (13); electrocution (6); or inhalation (2).

"Regardless of the cause, however, survival in most rural hospitals after cardiac arrest is low, usually less than 10 percent," Werman said. "The therapeutic and supportive care that is required for these patients is typically available only in specialty hospitals."

The study appears in a recent issue of the American Journal of Emergency Medicine.

The patients in this study had been hospitalized between Jan. 1, 1990, and March 30, 1994. About 75 percent of the helicopter transports were hospital-to-hospital transfers -- the remaining 25 percent of the subjects were transported from the scene of their injury. The patients came primarily from rural regions of central, eastern and southeastern Ohio.

While 31 of 69 patients (45 percent) with cardiovascular disease were discharged alive from the hospital, only 12 of 88 patients (14 percent) with other causes of cardiac arrest were discharged alive: six near-drowning; two suffocation; two electrical injury; and two noncardiac medical patients.

Of the 31 surviving patients with cardiovascular disease, eight were discharged from the hospital with a neurological disability, as was one patient who had suffered an electrical injury.

The researchers also found that the survivors were "significantly older" (average age 46 years) when compared with nonsurvivors (average age 34 years). But cardiovascular disease was less common in the younger people -- cardiac arrest in these patients was usually the result of a nonmedical cause, such as electrocution, or near-drowning.

It's common practice to transport survivors of cardiac arrest by air to specialty care centers. "Air transport minimizes out-of-hospital time for the patient and offers the services of an experienced critical care nurse or physician," Werman said.

Yet insurance companies are cracking down on physicians and demanding that medical professionals take a close look at which patients benefit the most from costly air transports, Werman said. A 60-mile, one-way helicopter transport costs about $3,000.

"Our study indicates which group will have the better prognosis when flown to a specialty hospital," Werman said. "For heart disease patients who survive a cardiac arrest, it's in our best interest to focus our resources, even our expensive resources, on bringing them to a tertiary care center by air as quickly as possible."

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