In France, patients with acute coronary syndromes (ACS) are usually transferred from remote hospitals to percutaneous coronary intervention (PCI) centres in mobile intensive care units (MICUs) with on-board medical staff. They are then returned to the remote hospitals by MICU 48 h after PCI. However, MICU transportation and beds in a PCI centre are in short supply. Therefore, we investigated clinical outcomes among intermediate-risk ACS patients who were transferred in private ambulances without an on-board medic or paramedic; and returned to the remote hospital sooner after PCI. In the French Alps, the RESURCOR network manages ‘SCA-Alp’ transfers using strict management protocols in ambulances with trained drivers and automatic external defibrillators, but without heart rhythm monitoring. We conducted an observational retrospective study that assessed outcomes (death and emergency return to the PCI centre within 48 h) in patients transferred using SCA-Alp. Our population comprised stabilized patients with ST-segment elevation myocardial infarction (STEMI) who returned to the remote hospital within 24–48 h of PCI, and uncomplicated patients with non-ST-segment elevation myocardial infarction (NSTEMI) within 24–72 h of symptom onset who come from and returned to (‘round-trip’) the remote hospital on the day of PCI (return < 12 h after PCI). Between 2010 and 2014, 101 STEMI and 490 NSTEMI patients were transferred using SCA-Alp. No adverse events occurred during transportation and no deaths were reported. Two of 591 patients (0.3% [95% confidence interval 0.1–1.4%]) experienced a stent thrombosis within 48 h of PCI that required a second urgent PCI; both were event free at 6-month follow-up. Inter-hospital transfer using SCA-Alp is associated with low event rates in intermediate-risk ACS patients, allowing a more streamlined use of medical facilities and freeing-up of beds in PCI centres.

中文翻译：

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没有医生，护理人员或护士在场的心肌梗死患者的早期医院间转运：来自法国区域急救网络的结果

在法国，患有急性冠状动脉综合症（ACS）的患者通常会从偏远医院转移到机动重症监护病房（MICU）的经皮冠状动脉介入治疗（PCI）中心，并配备机上医疗人员。然后，PCI后48小时，他们将由MICU返回到偏远医院。但是，PCI中心的MICU运输和病床供应短缺。因此，我们调查了中危ACS患者的临床结局，这些患者是由私人救护车转移而没有机上医护人员或护理人员。并在PCI后尽快返回偏远医院。在法国的阿尔卑斯山，RESURCOR网络在训练有素的驾驶员和自动体外除颤器的救护车中，使用严格的管理协议来管理“ SCA-Alp”传输，而没有心律监测。我们进行了一项观察性回顾性研究，评估了使用SCA-Alp转移的患者的结局（48小时内死亡和紧急返回PCI中心）。我们的人群包括稳定的ST段抬高型心肌梗死（STEMI）患者，这些患者在PCI的24-48小时内返回远程医院，而无并发症的非ST段抬高的心肌梗死（NSTEMI）患者则在PCI的24-72小时内返回在PCI日（从PCI返回12小时后返回）从远程医院来回（“往返”）的症状发作。在2010年至2014年之间，使用SCA-Alp转移了101例STEMI患者和490例NSTEMI患者。在运输过程中没有发生不良事件，也没有死亡报告。591例患者中有2例（0.3％[95％置信区间0.1–1。4％]）在PCI术后48小时内发生了支架内血栓形成，需要第二次紧急PCI。两者在6个月的随访中均无事件。使用SCA-Alp的医院间转移与中危ACS患者的低事件发生率相关，从而可以更简化医疗设施的使用并腾出PCI中心的病床。