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Updated: May 11, 2026
Prehospital Thrombolysis: A Manual from Berlin
Published on: November 27, 2013
Rationale for pre-hospital thrombolysis
F Romeo1, G M Rosano, V Rosano
1Department of Cardiology, University of Catania, Italy.
Insights
Rapid diagnosis and treatment of acute myocardial infarction in the field can significantly reduce delays. This approach aims to improve patient outcomes by initiating therapy sooner, bypassing critical hospital wait times.
Area of Science:
- Cardiology
- Emergency Medicine
- Public Health
Background:
- Early thrombolytic therapy for acute myocardial infarction (AMI) is crucial for preserving left ventricular function and improving prognosis.
- Most patients arrive at medical facilities over 2 hours after symptom onset, missing the optimal therapeutic window.
- Delays in treatment initiation stem from symptom recognition, transport, and in-hospital decision-making.
Purpose of the Study:
- To highlight the critical time delays in current acute myocardial infarction treatment protocols.
- To advocate for pre-hospital diagnosis and immediate treatment initiation to improve patient outcomes.
- To emphasize the need for hospitals to prioritize rapid intervention strategies for AMI.
Main Methods:
- Review of existing clinical trial data on early thrombolytic therapy efficacy.
- Analysis of time components contributing to treatment delays in acute myocardial infarction.
- Evaluation of the potential impact of field-based diagnosis and treatment.
Main Results:
- Significant delays are observed in patient presentation and hospital treatment initiation for AMI.
- Reducing pre-hospital and in-hospital delays is essential to capture the critical therapeutic window.
- Field-level diagnosis and immediate treatment can substantially decrease overall time to therapy.
Conclusions:
- The critical period for effective acute myocardial infarction therapy is often missed due to treatment delays.
- Developing field-based rapid intervention plans for diagnosis and treatment is a priority.
- Hospitals must prioritize strategies to significantly reduce the time from symptom onset to treatment initiation.
Abstract:
Early thrombolytic therapy in patients with acute myocardial infarction preserves left ventricular function and improves short- and long-term prognosis, as demonstrated in several trials. Unfortunately, most patients reach medical facilities more than 2 h into their infarction, and further time is lost in hospital before initiation of thrombolytic therapy. Thus, in the majority of patients with acute myocardial infarction the most critical period for effective therapy is missed. The delay between onset of cardiac symptoms suggestive of myocardial infarction and initiation of therapy has three components: (1) onset of symptoms, call for medical help; (2) travelling; (3) medical decision and start of treatment. Numerous studies show that it would be difficult to reduce the total time for onset of symptoms to call for medical help without an intensive media campaign. Recent observations documented the extraordinary delay in patient presentation and treatment in hospital. Thus, if the acute event could be diagnosed in the field and the team trained to initiate treatment immediately at home, time spent in travelling and in hospital will be significantly reduced. Therefore, the development of a plan of rapid intervention for diagnosis and treatment should become a major priority for all hospitals.
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