242 Regional emergency care network for the management of acute myocardial infarction. Experience of RESURCOR in the French northern Alps

Abstract

ProgramIn 2002, the regional agency of health in Rhone-alps area set up a health care network with the goal to optimise patient management, by a better coordination of existing facilities in the northern Alps. The ‘RESeau des URgences CORonariennes’ (RESURCOR), a subgroup of this network, is in charge of urgent cardiac care. The RESURCOR involves three French departments: Isere, Haute-Savoie and Savoie, which includes 1.8 million people with wide seasonal variations related to tourism. It coordinates urgent care between one university hospital, 12 general and three private hospitals, three emergency medical aid departments (SAMU), 12 mobile intensive care units (SMUR) and four cardiac interventional units. Emergency physicians and interventional and non-interventional cardiologists meet regularly to set up regional procedures for the management of patients suffering from acute myocardial infarction. It highlights the importance of reperfusion techniques, delays to have reperfusion and where the patient has to be admitted. A permanent regional registry monitors the management of these patients, the types of management and time.ResultsSince 2002, 3940 patients have been included in this registry. The accuracy was assessed at 84%. During the studying period, the number of primary percuntaneous interventions (PCI) gradually increased (33% in 2002 to 53% in 2008). The average time from the first medical contact to intravenous thrombolysis (62 mn in 2002 to 24 mn in 2008) and to arterial puncture of primary PCI (101 mn in 2002 to 78 mn in 2008) significantly decreased. Prehospital management by air increased from 3% in 2002 to 12% in 2008. According to the regional recommendations, 92% of the patients were directly admitted to an interventional coronary center in 2008.DiscussionRESURCOR submit recommendations for patient management and assess through a registry if the recommendations have been followed by physicians. Myocardial infarction was the first condition which the network took care of. Since this approach succeeded, we have followed the same pattern for the other diseases requiring cooperations between hospitals without the same technical equipment: Unstable angina, stroke (fibrinolysis sometimes required), cardiac arrest (urgent coronary angiography or extra corporeal membrane oxygenation sometimes required) and severe traumatology (trauma-system).ConclusionRESURCOR is a network for patient management which needs urgent care. It allows coordination of care between different institutions in a large area.ObjectifAmélioration des prises en charge des infarctus du myocarde.ProgrammeEn 2002, le RENAU (REseau Nord Alpin des urgences), réseau de prise en charge des urgences a été mis en place sur le Nord des Alpes, a l`initiative de l`Agence Régionale d`Hospitalisation. Au sein de ce réseau, la filière cardiologique s`est organisée autour du RESURCOR.Le RESURCOR couvre les départements de l`Isère, la Haute-Savoie et la Savoie, soit un total de 1.8 million d`individus, avec de larges variation saisonnières. Il concerne...