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Paramedic decision making: prehospital thrombolysis and beyond.
MedLine Citation:
PMID:  20682955     Owner:  NLM     Status:  In-Data-Review    
Abstract/OtherAbstract:
Background Mortality from acute myocardial infarction is influenced by the speed at which reperfusion therapy is delivered. In the UK, prehospital thrombolysis (PHT), administered by paramedics, has been developed to improve call to needle (CTN) times. Recently, it has been shown in randomised trials that mortality can be further reduced by primary percutaneous coronary intervention (PPCI). This project was developed to assess current ST-elevation myocardial infarction practice in a district general hospital and to prepare paramedics for PPCI. Methods Data were collected prospectively over a 12-month period for all patients who received thrombolysis for a presumed myocardial infarct. The primary outcome measures for each case were who delivered the thrombolysis, either the paramedic crew or the hospital, and if the patient did not receive PHT the reason why not. Secondary outcome measures included the CTN time. Results 153 patients received thrombolysis over the time period (99 men, 54 women, mean age 66±15 years). Of this group, 55 patients received PHT (35.9%) with a median CTN time of 36 min (inter-quartile range (IQR) 30-42 min). The commonest reason for exclusion from receiving PHT was that the patient's history did not fit the eligibility criteria (25% of cases). Conclusions Paramedics are able to deliver PHT promptly and safely. With the focus now on PPCI, it is anticipated that not only will paramedics be able to select patients for delivery to a heart attack centre for PPCI, they will be selecting many more patients for this treatment than have up to now received PHT.
Authors:
Alyson M Smith; Pamela J Hardy; David A Sandler; Justin Cooke
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Publication Detail:
Type:  Journal Article     Date:  2010-08-03
Journal Detail:
Title:  Emergency medicine journal : EMJ     Volume:  28     ISSN:  1472-0213     ISO Abbreviation:  Emerg Med J     Publication Date:  2011 Aug 
Date Detail:
Created Date:  2011-07-26     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  100963089     Medline TA:  Emerg Med J     Country:  England    
Other Details:
Languages:  eng     Pagination:  700-2     Citation Subset:  IM    
Affiliation:
Department of Cardiology, Chesterfield Royal Hospital, Calow, Chesterfield, Derbyshire, S44 5BL, UK; justin.cooke@chesterfieldroyal.nhs.uk.
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