Helicopter emergency medical service for time critical interfacility transfers of patients with cardiovascular emergencies

Background The goal of improving quality through centralisation of specialised medical services must be balanced against potential harm caused by delayed access to emergency treatments in rural areas. This study aims to assess the duration of transfers of critically ill patients with cardiovascular emergencies from smaller hospitals to major medical centres by a helicopter emergency medical service (HEMS) in Switzerland. Methods This retrospective observational cohort study includes all consecutive emergency interfacility transfers (IFTs) conducted by Switzerland’s largest HEMS provider between July 3rd, 2019, and March 31st, 2021. All patients with acute myocardial infarction, non-traumatic strokes, ruptured aortic aneurysms, and other acute vascular emergencies were included. The duration and distance of each HEMS IFT were compared to calculated distances and duration of travel for the same missions using ground-based transportation (GEMS). The ground-based mission distance beyond which the total mission duration of HEMS is expected to be faster than GEMS was calculated. Findings A total of 645 patients were transferred for stroke (n = 364), myocardial infarction (n = 252) and other acute vascular emergencies (n = 29). The median total mission duration from emergency call to landing at the destination was 59.9 (IQR 51.5 to 70.5) minutes. The median road distance for the same missions was 60 (IQR 43 to 72) km. Regression analysis revealed that HEMS is expected to be faster if the road distance is more than 51.3 km. Interpretation Centralisation of specialised medical services should be accompanied by a comprehensive and specialised rescue chain. HEMS in Switzerland ensures time-sensitive IFT in medical emergencies, even in topographically challenging terrain. Graphical Abstract

Single Center Experience in Vascular and Endovascular Surgery during the COVID-19 Pandemic: Walking on the Icy Road

Background: Along with other areas of specialization, the cardiovascular surgery clinic is a department that has a significant contribution to the COVID-19 pandemic process with both the management of vascular emergencies and the rapid and effective use of interventional methods. This study aims to present endovascular and open vascular surgical procedures performed in single center between March 2020 and December 2020 during the ongoing pandemic. Materials and methods: A total of 230 patients underwent open surgery 60 patients and endovascular / interventional treatment 170 patients by the Cardiovascular Surgery clinic were included in the study. It was aimed to determine the procedural details of the patients, follow-up results, complications and mortality rates. The compatibility of the variables to normal distribution was examined using visual and analytical methods. The Shapiro-Wilk test was used to check the normal distribution of continuous variables. Results: In the open vascular surgery group, the mean age was 51.4±23.2 years (range 12–90 years). Sixteen (26.7%) patients were female and 44 (73.3%) male. The median follow-up from the time of the open vascular procedure was 4.3±1.2 months. There were ten (16.7%) minor complications. There were five deaths after procedures. In the endovascular / interventional group, the mean age was 58.5±18.6 years (range 18–94 years). Ninety one (53.5%) patients were female and 79 (46.5%) male. The median follow-up from the time of the drug-eluting balloon angioplasty and pharmacomechanical thrombectomy patients were 4.0±1.1 months. There were thirty four (20%) minor complications and two deaths after procedures. Conclusion: Our experience and successful results shows how surgical and interventional procedures participated in the care of hospitalized COVID-19 patients during the height of the coronavirus pandemic.

P132 TRAVERSING: Transfer of thoracic Aortic Vascular Emergencies to Regional Specialist Institutes Group

Introduction The incidence of Acute Aortic Syndrome (AAS) is rising. The Department of Health is considering a supra regional tier of centralisation for complex aortic care. No standardised pathway exists to guide the transfer of patients with AAS, despite increasing evidence from coroners and the Healthcare Safety Investigation Board of delayed transfers and miscommunication costing lives. This study aims to deliver a pathway for the safe transfer of patients with suspected AAS to a specialist aortic centre through multidisciplinary Delphi consensus. Methods The researchers will create an interdisciplinary Steering Group to oversee the study, which will identify appropriate stakeholders for inclusion in the Delphi process. A systematic review will be performed to summarise existing evidence and highlight gaps in knowledge where consensus is required. The Steering Group will create, circulate and interpret the Delphi questionnaire. The outcomes will also enable determination of criteria for audit that should become the standard for ensuring a safe and efficient process for patient transfer to a complex aortic centre. Results Results will provide inter-disciplinary guidance to healthcare professionals for early management and transfer of patients with suspected AAS, and prevent unnecessary transfer, thereby improving outcomes, ensuring equity of access to specialist aortic care for patients. Results will also provide audit standards through which future improvements can be realised. Conclusion This study is reliant upon collaboration between multidisciplinary healthcare providers, qualitative researchers and patients. Its success will streamline emergency pathways in the management of AAS, saving lives and resources, with inbuilt mechanisms for continuous review and improvement.

Emergency endovascular repair of aortoiliac aneurysms in COVID-19 times

In this paper, we describe a case series of four patients who were admitted with emergencies related to aortic aneurysms over a 3-day period and were treated with endovascular repair. The first patient was an 81-year-old female with a history of abdominal pain and a ruptured aortic aneurysm diagnosed by AngioCT-scan. The second patient was a 63-year-old male with a history of oral digestive bleeding and an AngioCT-scan showing an aortoenteric fistula. The third patient was a 77-year-old female with sudden-onset abdominal pain and ruptured right common iliac aneurysm. The fourth patient presented with abdominal pain and an AngioCT-scan showed aortic rupture. All four patients were discharged with no major complications or surgical mortality. These case series show that despite the Covid-19 pandemic situation, since elective surgeries decreased, vascular emergencies have increased.