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The Effect of Implementation of the American Heart Association Mission Lifeline PreAct Algorithm for Prehospital

Juliana Tolles1,2, Nichole Bosson1,2,3, Amy H Kaji1,2

  • 1Harbor-UCLA Medical Center, Torrance, CaliforniaUSA.

Prehospital and Disaster Medicine
|May 21, 2020
PubMed

Insights

The Mission Lifeline PreAct STEMI algorithm increased the positive predictive value (PPV) of prehospital activation for ST-elevation myocardial infarction (STEMI) patients. This improved accuracy in identifying true STEMI cases without affecting first-medical-contact-to-balloon times.

Area of Science:

  • Cardiology
  • Emergency Medicine
  • Public Health

Background:

  • Prehospital activation of cardiac catheterization laboratories aims to reduce treatment times for ST-elevation myocardial infarction (STEMI).
  • High rates of false-positive activations can delay care for true STEMI patients.
  • The American Heart Association developed the Mission Lifeline PreAct STEMI algorithm to improve activation accuracy.

Purpose of the Study:

  • To evaluate the impact of the Mission Lifeline PreAct STEMI algorithm on the positive predictive value (PPV) of prehospital activations.
  • To assess changes in first-medical-contact-to-balloon (FMC2B) time following algorithm implementation.

Main Methods:

  • An observational pre-/post-study design was used in Los Angeles County (LAC).
  • The study compared PPV of cardiac catheterization laboratory activations for percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG) before and after PreAct algorithm implementation.
  • FMC2B time was analyzed as a secondary outcome.

Main Results:

  • Implementation of the PreAct algorithm was associated with an increase in PPV from 37.9% to 48.6% (OR 1.4).
  • Overall cardiac catheterization laboratory activations decreased post-intervention, but activations for true STEMI increased.
  • No significant change in average FMC2B time was observed.

Conclusions:

  • The PreAct algorithm successfully increased the PPV of prehospital STEMI activations in the LAC EMS system.
  • The algorithm helped reduce variability in activation accuracy between medical centers.
  • Further optimization may be needed to impact FMC2B times.
Abstract

Keywords:
cardiac catheterizationmyocardial infarctionprehospital emergency care

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