• Karsten Knobloch, Imke Dehn, Nawid Khaladj, Christian Hagl, Peter M Vogt, and Axel Haverich.
• Plastic, hand and reconstructive surgery, Hannover Medical School, Germany. kknobi@yahoo.com
• Air Med. J. 2009 May 1; 28 (3): 146-53.

BackgroundWe thought to evaluate the impact of the mode of physician-based transportation (helicopter emergency medical service [HEMS] vs. ground-based emergency medical service [EMS]) on short- and long-term survival among patients suffering acute aortic dissection type A (AADA) as a primary end-point.MethodsOne-hundred-seventy-seven AADA patients (59 +/- 13 years) were included who were admitted to a cardiothoracic surgery department with comprehensive transfer documentation. Cox proportional hazard models and log-rank tests were performed as well as Kaplan-Meier survival curves. Follow-up was 93% over 5 +/- 2(3/4) years.ResultsCox proportional hazard model found no mortality difference for HEMS versus EMS on primary transport (P = .5), as well as log-rank (Mantel Cox) on interhospital transport (P = 0.5). HEMS interhospital transfer was eightfold more expensive than EMS (HEMS, 3,871; EMS, 497; P = .01). Ninety-nine patients (56%) were alive at follow-up (mean survival, 1,153 days +/- 1,124). Mortality after surgery was 2% (3/177) within the first hour, 5% (8/177) within 6 hours, 6% (10/177) within 12 hours, 11% (20/177) within 24 hours, 13% (23/177) within 48 hours, 14% (25/177) within 72 hours, and 26% (46/177) within 30 days after surgery.ConclusionsWe found no advantage of survival rates among patients suffering from AADA who were transferred by either HEMS or EMS in primary or secondary transport. Although HEMS traveled a distance more than twofold longer than ground-based EMS at the same mission time, HEMS was eightfold more expensive than ground-based EMS in AADA.

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