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March 18, 1988

Transfer of Acutely Ill Cardiac Patients for Definitive CareDemonstrated Safety in 755 Cases

JAMA. 1988;259(11):1695-1698. doi:10.1001/jama.1988.03720110057035

The safety of transporting acutely ill cardiac patients for cardiac catheterization has not been established. We describe 755 consecutive patients sent by ambulance from community hospitals to a tertiary center during an 18-month period. Eighty-seven percent of the patients were class III or IV New York Heart Association classification for angina. At catheterization, left ventricular dysfunction (ejection fraction <55%) was present in 40%. Forty-three percent of patients required urgent intervention (coronary artery bypass surgery or percutaneous transluminal coronary angioplasty). The patients were transported by paramedic ambulance up to 99 km (≤62 miles) without a physician in attendance. No complications occurred in patients transferred within our guidelines. We believe that seriously ill cardiac patients can be transferred safely for definitive care. A single tertiary center providing immediate access to catheterization and surgical facilities can service a large population and many community hospitals.

(JAMA 1988;259:1695-1698)