Document Detail


Paramedic-administered prehospital thrombolysis is safe and reduces time to treatment.
MedLine Citation:
PMID:  19834522     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
INTRODUCTION: The Kapiti Coast region is remote from Wellington Hospital with an ambulance transport time of 1 hour. To reduce delays in the treatment of myocardial infarction (MI), a prehospital thrombolysis (PHT) programme was initiated in 2003. METHODS: This study evaluated outcomes of the Kapiti PHT programme between 2003 and 2007. Paramedics attending patients with suspected MI-transmitted electrocardiograms to our Coronary Care Unit where a physician made the decision whether or not to thrombolyse. Thrombolysis was then administered by a paramedic. Patients from the Kapiti region treated with in-hospital thrombolysis (IHT) between 1999 and 2003 formed the control group. RESULTS: A total of 50 Kapiti patients received PHT. The group receiving IHT were older than those receiving PHT but other baseline characteristics were similar. No patients without MI or with a contraindication received PHT. In the PHT group there was one minor bleed but no major bleeding, stroke or death occurred during transport to hospital. The median scene to thrombolytic time for PHT was 89 minutes faster (44 minutes versus 133, P<0.0001) than in patients transferred for IHT. The median scene to thrombolytic time for PHT was similar to the door to thrombolytic time for IHT (P=0.13). In-hospital mortality in the PHT group (8.0%) was similar to the IHT group (6.0%, P=1.0) but heart failure was reduced (10% vs. 26%, P=0.04) CONCLUSIONS: Prehospital thrombolysis administered by paramedics is safe and reduces the time to treatment and was associated with a reduction in heart failure.
Authors:
Anil M Ranchord; Sandhir Prasad; Phillip Matsis; Scott A Harding
Publication Detail:
Type:  Comparative Study; Journal Article     Date:  2009-09-11
Journal Detail:
Title:  The New Zealand medical journal     Volume:  122     ISSN:  1175-8716     ISO Abbreviation:  N. Z. Med. J.     Publication Date:  2009 Sep 
Date Detail:
Created Date:  2009-10-16     Completed Date:  2009-11-03     Revised Date:  2010-10-22    
Medline Journal Info:
Nlm Unique ID:  0401067     Medline TA:  N Z Med J     Country:  New Zealand    
Other Details:
Languages:  eng     Pagination:  47-53     Citation Subset:  IM    
Affiliation:
Department of Cardiology, Wellington Hospital, Wellington South, New Zealand.
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MeSH Terms
Descriptor/Qualifier:
Aged
Allied Health Personnel*
Electrocardiography
Emergency Medical Services / methods*
Female
Fibrinolytic Agents / therapeutic use*
Follow-Up Studies
Humans
Male
Middle Aged
Myocardial Infarction / drug therapy*,  mortality,  physiopathology
New Zealand / epidemiology
Retrospective Studies
Survival Rate
Thrombolytic Therapy / methods*
Time Factors
Treatment Outcome
Chemical
Reg. No./Substance:
0/Fibrinolytic Agents

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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