An Affair of the Heart

This edition of Air Medical Journal features a cardiovascular focus and represents our second theme issue. The first special issue (April/May/June 1999) reviewed neurologic events and was edited by William Barsan, MD, of the University of Michigan. In response to comments on that issue, a number of changes have taken place, such as the inclusion of original research in this issue. In the first of our featured articles, David Dries, MD, discusses some upcoming trends in advanced cardiac life support (ACLS) protocols. Certainly, the recent favorable data for amiodarone in out-of-hospital cardiac arrest warrant attention in acute cardiac resuscitation. Other intriguing issues include the role of glucose in resuscitation fluids and the possibifity of a shift to nonadrenergic pressor agents given the dismal performance of many ACLS drugs now used. In the second article, Jeanette Goltermann, RN, describes reperfusion strategies in patients with acute myocardial infarction. Clearly, the American health system has an insufficient number of cardiac catheterization facilities to support the demand of patients with acute coronary conditions despite the obvious benefits of acute angioplasty with stenting. Ms. Goitermann reviews some of the associated data for various medical strategies for the acute cardiac patient. Our third cardiovascular article comes from Mark Lowell, MD, medical director of Survival Flight at the University of Michigan and director of the ED chest pain unit at the university medical center. He reviews life-threatening causes of chest pain and treatment strategies for acute ischemic cardiac symptoms. Finally, Dr. Lowell addresses the question of patients who require urgent air medical transfer to a cardiac referral center. Two original research articles included in this issue compliment the topics discussed above. Leanne Perez, RN, and coworkers from Stanford Life Fright describe oxygenation and ventilation experiences associated with transportation of intubated adults. A wide variety of practices are identified in this survey of air transport agencies conducted during 1998. This work is remarkable in that 78% of surveys mailed were returned. In the second original article, Steve Talbert, RN, a flight nurse at the University of Kentucky Air Medical Service and the incoming editor of AirMed, provides some of his initial data examining propriety of use for air medical helicopters in interfacility transports. He notes that not all physiologic information is valuable in determining the need for air medical transfer. On the other hand, type and quantity of interventions with relative urgency may be more helpful in distinguishing whether the helicopter is necessary. Mr. Talbert also addresses a critical ongoing need of our industry--developing a standard for utilization. We look forward to your comments on our second theme issue as we continue into a new millennium.