Clinical events and treatment in prehospital patients with ST-segment elevation myocardial infarction
Damien Ryan1, Alan M Craig, Linda Turner
1Division of Prehospital Care, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada.
Insights
Clinically significant events and advanced treatments are frequent during prehospital care for ST-elevation myocardial infarction (STEMI) patients. Many patients require interventions like CPR or defibrillation before reaching a percutaneous coronary intervention center.
Area of Science:
- Cardiology
- Emergency Medicine
- Prehospital Care
Background:
- Limited understanding of prehospital events and treatments for ST-elevation myocardial infarction (STEMI) patients.
- Focus on clinically significant events and advanced care during out-of-hospital transport.
Purpose of the Study:
- To determine the proportion of community STEMI patients experiencing critical events or receiving advanced care before hospital arrival.
- Assess prehospital care needs for STEMI patients.
Main Methods:
- Retrospective review of 487 STEMI patients in an urban EMS system.
- Categorization into direct transport (group 1) and interfacility transfer (group 2).
- Recording of predefined clinically important events and advanced care treatments.
Main Results:
- 92/342 (26.9%) of direct transport patients had events (bradycardia, hypotension, cardiac arrest).
- 33/342 (9.6%) of direct transport patients received advanced care (morphine, atropine).
- 8 direct transport patients and 3 interfacility transfer patients received CPR or defibrillation.
Conclusions:
- Clinically important events and advanced treatments are common in prehospital STEMI care.
- Several STEMI patients require advanced interventions like CPR or defibrillation during transport.
- Further research is needed to optimize EMS scope of practice for STEMI patients.
Background:
Little is known about clinically important events and advanced care treatment that patients with ST-segment elevation myocardial infarction (STEMI) encounter in the prehospital setting.
Objectives:
We sought to determine the proportion of community patients with STEMI who experienced a clinically important event or received advanced care treatment prior to arrival at a designated percutaneous coronary intervention (PCI) laboratory or emergency department (ED).
Methods:
We reviewed 487 consecutive community patients with STEMI between May 2008 and June 2009. All patients were geographically within a single large "third-service" urban emergency medical services (EMS) system and were transported by paramedics with an advanced care scope of practice. We recorded predefined clinically important events and advanced care treatment that occurred in patients being transported directly to a PCI laboratory or ED (group 1) or interfacility transfer to a PCI laboratory (group 2).
Results:
One or more clinically important events occurred in 92 of 342 (26.9%) group 1 patients and nine of 145 (6.2%) group 2 patients. The most common were sinus bradycardia, hypotension, and cardiac arrest. Additionally, 33 of 342 (9.6%) group 1 and nine of 145 (6.2%) group 2 patients received one or more advanced care treatments. The most common were administration of morphine and administration of atropine. Eight group 1 patients and three group 2 patients received cardiopulmonary resuscitation (CPR) or defibrillation.
Conclusions:
Clinically important events and advanced care treatment are common in community STEMI patients undergoing prehospital transport or interfacility transfer to a PCI center. Several patients required CPR or defibrillation. Further research is needed to define the clinical experience of STEMI patients during the out-of-hospital phase and the scope of practice required of EMS providers to safely manage these patients.
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