Chapter 18 / Transport of the Patient 301
whether other patients should be transferred for emergency revascularization. Resources
spent on preserving life are easily justifiable in this subgroup because the majority of hos-
pital survivors have a good short-term prognosis. Conversely, expensive technology
should not be employed to unnecessarily prolong life when death is inevitable.
CONCLUSION
Safety during transport depends on the quality of the ambulance or helicopter per-
sonnel and the equipment available. In published studies, patients have been selected
from a much larger population presenting with ST-segment elevation or left bundle-
branch block. Transfer times and distances have been relatively short; delays are likely
to be longer in the real world and when extra measures are required to stabilize patients
in cardiogenic shock. Nevertheless, acute transfer for primary or rescue PTCA is feasi-
ble and safe. Patients at high risk for developing cardiogenic shock should be consid-
ered for early transfer to a tertiary-care hospital with revascularization capabilities. For
selected patients with cardiogenic shock, emergency transfer for coronary revascular-
ization may be their best chance for survival.
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