Prospective observational cohort study of time saved by prehospital
thrombolysis for ST elevation myocardial infarction delivered by
paramedics |
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| Authors: | David K Pedley Kim Bissett Elizabeth M Connolly Carol G Goodman Ian Golding T H Pringle G P McNeill S D Pringle M C Jones |
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| Institution: | 1 Ninewells Hospital and Medical School, Dundee DD1 9SY;2 Scottish Ambulance Service, Dundee DD3 8PQ |
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| Abstract: | Objectives To evaluate a system of prehospital thrombolysis,
delivered by paramedics, in meeting the national service framework''s targets
for the management of acute myocardial infarction.Design Prospective observational cohort study comparing patients
with suspected acute myocardial infarction considered for thrombolysis in the
prehospital environment with patients treated in hospital.Setting The catchment area of a large teaching hospital, including
urban and rural areas.Participants 201 patients presenting concurrently over a 12 month
period who had changes to the electrocardiogram that were diagnostic of acute
myocardial infarction or who received thrombolysis for suspected acute
myocardial infarction.Main outcome measures Time from first medical contact to initiation
of thrombolysis (call to needle time), number of patients given thrombolysis
appropriately, and all cause mortality in hospital.Results The median call to needle time for patients treated before
arriving in hospital (n=28) was 52 (95% confidence interval 41 to 62) minutes.
Patients from similar rural areas who were treated in hospital (n=43) had a
median time of 125 (104 to 140) minutes. This represents a median time saved
of 73 minutes (P < 0.001). Sixty minutes after medical contact 64% of
patients (18/28) treated before arrival in hospital had received thrombolysis;
this compares with 4% of patients (2/43) in a cohort from similar areas.
Median call to needle time for patients from urban areas (n=107) was 80 (78 to
93) minutes. Myocardial infarction was confirmed in 89% of patients (25/28)
who had received prehospital thrombolysis; this compares with 92% (138/150) in
the two groups of patients receiving thrombolysis in hospital.Conclusions Thrombolysis delivered by paramedics with support from
the base hospital can meet the national targets for early thrombolysis. The
system has been shown to work well and can be introduced without delay. |
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