The potential for prehospital thrombolytic therapy

Area of Science:

• Cardiology
• Emergency Medicine
• Medical Technology

Background:

• Early thrombolytic therapy is crucial for acute myocardial infarction (AMI) outcomes.
• Reducing time from symptom onset to treatment is challenging with current patient management.
• Prehospital interventions are key to improving AMI treatment timelines.

Purpose of the Study:

• To evaluate the feasibility of the Myocardial Infarction Triage and Intervention Project (MITI) for prehospital AMI diagnosis.
• To assess the effectiveness of trained paramedics and remote ECG diagnosis in initiating timely thrombolytic therapy.
• To determine the proportion of AMI patients eligible for prehospital thrombolytic therapy.

Main Methods:

• The MITI program utilized trained paramedics, a standardized checklist, and a portable 12-lead ECG with cellular transmission.
• Emergency medical technicians evaluated 2,472 patients with chest pain of presumed cardiac origin.
• Remote ECG interpretation by emergency department physicians facilitated diagnosis and treatment decisions.

Main Results:

• Out of 2,472 patients, 677 met criteria for potential thrombolytic therapy, with 522 ECGs successfully transmitted.
• 107 patients (20.5% of transmitted ECGs) had ST-segment elevation, meeting criteria for therapy initiation.
• Only 105 of 453 hospitalized AMI patients (23%) were identified as eligible for prehospital thrombolytic therapy.

Conclusions:

• The MITI program demonstrates a feasible approach to prehospital AMI diagnosis and intervention.
• Specialized paramedics and remote ECG technology can identify eligible patients for early thrombolytic therapy.
• Further optimization is needed to increase the percentage of AMI patients receiving prehospital thrombolytic therapy.