Prehospital activation of cardiac catheterization teams in ST-segment elevation myocardial infarction
Eduardo Franco1, Alonso Mateos2, Carlos Acebal1
1Cardiovascular Institute, Hospital Clínico San Carlos, Madrid, Spain.
Insights
Prehospital activation of cardiac catheterization teams significantly reduced reperfusion times for ST-elevation myocardial infarction (STEMI) patients. This new protocol improved system delay by 37 minutes, enhancing patient outcomes.
Area of Science:
- Cardiology
- Emergency Medicine
- Healthcare Systems
Background:
- Clinical guidelines recommend prehospital activation of cardiac catheterization teams for ST-elevation myocardial infarction (STEMI).
- Previous protocols at the center involved activation upon patient hospital arrival.
- A new primary angioplasty activation protocol was implemented in January 2011.
Purpose of the Study:
- To quantify the impact of a new prehospital activation protocol on reperfusion times in STEMI patients.
- To evaluate changes in system delay and cardiac catheterization lab activation delay.
Main Methods:
- Analysis of 173 consecutive STEMI patients diagnosed within 12 hours of symptom onset.
- Comparison of reperfusion times before and after the implementation of the prehospital activation protocol.
- Definition of cath lab activation delay as the time from hospital arrival to angioplasty initiation.
Main Results:
- The new protocol reduced overall system delay by 37 minutes (166 min vs. 129 min).
- Cardiac catheterization lab activation delay decreased by 64% (55 min vs. 20 min), particularly outside working hours.
- The percentage of patients treated within 120 minutes increased from 14.5% to 41.8%.
Conclusions:
- Prehospital activation of cardiac catheterization teams leads to earlier reperfusion in STEMI patients.
- The implemented protocol demonstrated a significant improvement in system efficiency and patient treatment times.
Introduction And Objectives:
Current clinical guidelines for ST-segment elevation myocardial infarction (STEMI) suggest prehospital activation of the cardiac catheterization team. In previous protocols in our center activation occurred once patients arrived at the hospital. In January 2011, we initiated a new primary angioplasty activation protocol from prehospital locations. Our objective was to quantify the influence of this change on reperfusion times.
Methods:
A total of 173 consecutive STEMI patients (n=73/100 before/after initiation of the new protocol), diagnosed in a prehospital setting within 12 hours of symptom onset, were analyzed. The time between the patient's arrival at the hospital and beginning of the angioplasty procedure was termed the cath lab activation delay.
Results:
The new protocol resulted in a 37-min reduction in system delay (166 [132-235] min before vs. 129 [105-166] min after, p<0.001), mostly driven by a 64% reduction in cath lab activation delay (55 [0-79] min before vs. 20 [0-54] min after, p=0.001). This reduction was mainly observed outside working hours. The percentage of patients treated with a system delay ≤ 120 min increased from 14.5% before the new protocol to 41.8% afterwards (p=0.001).
Conclusions:
Prehospital activation of the cardiac catheterization team resulted in earlier reperfusion of STEMI patients.
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