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Prehospital Thrombolysis: A Manual from Berlin
05:52

Prehospital Thrombolysis: A Manual from Berlin

Published on: November 26, 2013

Audit of thrombolysis initiated in an accident and emergency department

P A Nee1, A J Gray, M A Martin

  • 1Stockport Infirmary, UK.

Quality in Health Care : QHC
|February 7, 1994
PubMed

Insights

Early thrombolysis for acute myocardial infarction significantly reduces mortality. Implementing treatment in the A and E department, instead of the coronary care unit, drastically cut "door to needle" and "pain to needle" times without increasing adverse effects.

Area of Science:

  • Cardiology
  • Emergency Medicine
  • Health Services Research

Background:

  • Early thrombolytic therapy is crucial for reducing mortality in acute myocardial infarction (AMI).
  • In-hospital delays in administering thrombolysis contribute to poorer patient outcomes.
  • Optimizing treatment pathways in emergency settings is essential for timely AMI care.

Purpose of the Study:

  • To evaluate a novel system for reducing in-hospital delays in administering thrombolysis for AMI.
  • To compare "pain to needle" and "door to needle" times between traditional and modified treatment protocols.
  • To assess the safety and efficacy of initiating thrombolysis in an Accident and Emergency (A and E) department.

Main Methods:

  • A retrospective audit of 43 patients (group 1) who received thrombolysis in the Coronary Care Unit (CCU) after transfer.
  • A prospective audit of 53 patients, with 23 (group 2b) receiving thrombolysis in the A and E department and 30 (group 2a) in the CCU.
  • Thrombolysis administration in the A and E department was performed by medical staff after oral confirmation and ECG transmission.

Main Results:

  • Patients receiving thrombolysis in the A and E department (group 2b) showed significantly reduced "door to needle" (38 min vs. 121 min) and "pain to needle" (141 min vs. 237 min) times compared to CCU administration.
  • No significant difference in case mix, pre-hospital delay, or transfer time was observed between groups.
  • The incidence of adverse effects and in-hospital mortality (9.9%) were not significantly different between the groups.

Conclusions:

  • Initiating thrombolysis in the A and E department for selected acute myocardial infarction patients is safe and effective.
  • This streamlined approach significantly reduces critical treatment delays, improving patient care pathways.
  • Decentralizing early thrombolysis administration can lead to better clinical outcomes in AMI management.

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