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The Impact of COVID-19 on Lombardy Region ST-Elevation Myocardial Infarction Emergency Medical System Network-A

Giuseppe Stirparo1,2, Lorenzo Bellini1, Giuseppe Ristagno3,4

  • 1Faculty of Medicine, School of Public Health, University of Vita-Salute San Raffaele, Via Olgettina 60, 20090 Milano, Italy.

Journal of Clinical Medicine
|October 14, 2022
PubMed

Insights

The COVID-19 pandemic increased emergency medical system response times for ST-elevation myocardial infarction (STEMI) patients. However, pre-hospital treatment protocols, like fibrinolysis, remained unchanged during this period.

Area of Science:

  • Cardiology
  • Emergency Medicine
  • Public Health

Background:

  • The COVID-19 pandemic significantly disrupted emergency medical systems globally.
  • Limited data exists on the pandemic's impact on ST-elevation myocardial infarction (STEMI) time-sensitive networks.
  • Understanding these impacts is crucial for optimizing pre-hospital STEMI management, including fibrinolysis protocols.

Purpose of the Study:

  • To investigate the effects of the COVID-19 pandemic on emergency medical system response times for STEMI patients.
  • To assess changes in STEMI diagnosis rates and hospital access during the pandemic.
  • To evaluate the adherence to pre-hospital clinical protocols during the pandemic.

Main Methods:

  • Retrospective observational cohort study.
  • Analysis of STEMI rescues from the Lombardy EMS registry (January 2019 - December 2021).
  • Comparison of pre-pandemic, first wave, and later pandemic periods.

Main Results:

  • A reduction in STEMI diagnoses was observed in March 2020 compared to March 2019 (OR 0.76).
  • Average emergency medical mission times increased from 57.7 min in 2019 to 64.7 min in 2020 and 63.1 min in 2021.
  • The number of specialized STEMI treatment centers (HUBs) decreased significantly from 52 pre-pandemic to 13 during the first wave.

Conclusions:

  • The COVID-19 pandemic led to increased transportation times for STEMI patients.
  • Despite longer transport times, the out-of-hospital clinical management approach for STEMI did not change.
  • Fibrinolysis was not implemented in the out-of-hospital setting during the study period, irrespective of pandemic-related changes.

Keywords:
COVID-19Lombardy regionSTEMIemergency care

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