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Updated: Mar 17, 2026
Prehospital Thrombolysis: A Manual from Berlin
Published on: November 26, 2013
Pre-hospital thrombolysis in ST-segment elevation myocardial infarction: a regional Australian experience
Arshad A Khan1, Trent Williams2, Lindsay Savage2
1John Hunter Hospital, Newcastle, NSW andrew.boyle@newcastle.edu.au.
Insights
Pre-hospital thrombolysis (PHT) administered by paramedics to ST-segment elevation myocardial infarction (STEMI) patients in rural Australia is safe and effective. This strategy showed good clinical outcomes with low mortality and bleeding rates.
Area of Science:
- Cardiology
- Emergency Medicine
- Public Health
Background:
- The Hunter New England Local Health District uses a care system for ST-segment elevation myocardial infarction (STEMI) patients.
- This system involves pre-hospital thrombolysis (PHT) for patients >60 minutes from a cardiac catheterisation laboratory (CCL) and primary percutaneous coronary intervention (PCI) for others.
Purpose of the Study:
- To assess the safety and effectiveness of a pre-hospital diagnosis strategy for STEMI patients.
- The strategy allocates patients to PHT or primary PCI based on travel time to the CCL.
Main Methods:
- A prospective, non-randomised, single-centre case series of STEMI patients diagnosed via pre-hospital electrocardiogram (ECG).
- Data collected from August 2008 to August 2013 at John Hunter Hospital, Newcastle.
- Primary endpoints were 12-month all-cause mortality and bleeding incidence.
Main Results:
- 484 STEMI patients diagnosed via pre-hospital ECG; 150 received PHT, 334 underwent primary PCI.
- Median time from first medical contact (FMC) to PHT was 35 minutes; to balloon inflation was 130 minutes.
- 12-month all-cause mortality was 7.0% (PHT 6.7%, PCI 7.2%). Major bleeding occurred in 1.3% of PHT patients; none in the PCI group.
Conclusions:
- Pre-hospital thrombolysis (PHT) can be safely administered by paramedical staff in regional and rural settings.
- The pre-hospital diagnosis strategy for STEMI patients demonstrated good clinical outcomes.
- This approach is effective for managing STEMI in areas distant from cardiac catheterisation laboratories.
Objective:
The system of care in the Hunter New England Local Health District for patients with ST-segment elevation myocardial infarction (STEMI) foresees pre-hospital thrombolysis (PHT) administered by paramedics to patients more than 60 minutes from the cardiac catheterisation laboratory (CCL), and primary percutaneous coronary intervention (PCI) at the CCL for others. We assessed the safety and effectiveness of the pre-hospital diagnosis strategy, which allocates patients to PHT or primary PCI according to travel time to the CCL.
Design, Setting And Participants:
Prospective, non-randomised, consecutive, single-centre case series of STEMI patients diagnosed on the basis of a pre-hospital electrocardiogram (ECG), from August 2008 to August 2013. All patients were treated at the tertiary referral hospital (John Hunter Hospital, Newcastle).
Main Outcome Measures:
The primary efficacy endpoint was all-cause mortality at 12 months; the primary safety endpoint was bleeding.
Results:
STEMI was diagnosed in 484 patients on the basis of pre-hospital ECG; 150 were administered PHT and 334 underwent primary PCI. The median time from first medical contact (FMC) to PHT was 35 minutes (IQR, 28-43 min) and to balloon inflation 130 minutes (IQR, 100-150 min). In the PHT group, 37 patients (27%) needed rescue PCI (median time, 4 h; IQR, 3-5 h). The 12-month all-cause mortality rate was 7.0% (PHT, 6.7%; PCI, 7.2%). The incidence of major bleeding (TIMI criteria) in the PHT group was 1.3%; no patients in the primary PCI group experienced major bleeding.
Conclusion:
PHT can be delivered safely by paramedical staff in regional and rural Australia with good clinical outcomes.
