[Prehospital care of patients with acute ST elevation myocardial infarction]
1Medizinische Klinik II, Charité, Campus Benjamin Franklin, Berlin. hans-richard.arntz@charite.de
Insights
Prehospital therapy for ST elevation myocardial infarction is similar to in-hospital care, but early thrombolysis offers superior outcomes. Biomarkers are not useful pre-hospital, but ECG is crucial for timely treatment.
Area of Science:
- Cardiology
- Emergency Medicine
Context:
- Prehospital care for ST elevation myocardial infarction (STEMI) is critical for patient outcomes.
- Timely reperfusion therapy significantly impacts mortality and morbidity.
Purpose:
- To evaluate the efficacy and role of prehospital interventions for STEMI.
- To compare outcomes of prehospital thrombolysis versus in-hospital percutaneous coronary intervention (PCI).
Summary:
- Prehospital STEMI management mirrors in-hospital care for pain, medications (beta-blockers, antiplatelets, thrombin antagonists), and blood pressure/heart failure treatment.
- A 12-lead ECG is essential pre-hospital; biomarkers are not indicated.
- Out-of-hospital thrombolysis is a safe and effective reperfusion strategy, superior to delayed in-hospital initiation, especially within the first 2 hours of symptom onset.
- Prehospital thrombolysis is recommended in areas with limited interventional facilities and for earliest reperfusion.
- Rescue PCI shows promise for failed thrombolysis, while facilitated PCI requires further definition.
Impact:
- Optimizing prehospital STEMI protocols can improve patient survival and reduce long-term complications.
- Routine prehospital thrombolysis can bridge the gap in areas with limited PCI resources, ensuring timely reperfusion.
- This approach emphasizes the importance of early intervention in the critical window for STEMI management.
Abstract:
Symptomatic prehospital therapy of patients suffering from an ST elevation myocardial infarction basically does not differ from in-hospital care regarding pain relief, beta-blockers, antiplatelets, and thrombin antagonists as well as therapy of elevated blood pressure and acute heart failure. Precondition of a targeted and adequate treatment, however, is the twelve-lead ECG whose reliability does not differ from the ECG in the hospital. Biomarkers have no role in the prehospital setting. Out-of-hospital thrombolysis, which has been proven to be superior to later in-hospital initiation, can be used as a safe strategy for reperfusion. Only the prehospital phase offers a chance to treat the majority of patients within the first 2 h after symptom onset, a time window where thrombolysis results in equal or even better outcomes with respect to mortality, if compared to percutaneous intervention. Therefore, prehospital thrombolysis should be routinely applied in areas with a weak infrastructure and few and less experienced facilities for intervention but should also be considered a principal way for earliest start of reperfusion therapy. There is increasing evidence supporting the "rescue PCI" concept in patients in whom thrombolysis has failed. By contrast, the role of "facilitated PCI" still has to be defined.
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