Related Experiment Video
Updated: Jul 4, 2025
Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
DO THE GUIDELINES GUIDE THE BELGRADE EMERGENCY MEDICAL SERVICE PHYSICIANS THROUGH THE MANAGEMENT OF ACUTE
Goran Čolaković1, Slađana Anđelić1, Snežana Bogunović1
1Emergency Medical Services, Belgrade, Serbia.
Insights
Belgrade Emergency Medical Service (EMS) adequately applies ST-elevation myocardial infarction (STEMI) guidelines, showing increased dual antiplatelet therapy use. Response times met benchmarks, indicating effective STEMI patient care.
Area of Science:
- Cardiology
- Emergency Medicine
- Public Health
Background:
- Acute ST-elevation myocardial infarction (STEMI) requires timely diagnosis and treatment.
- Adherence to international and local guidelines is crucial for optimal patient outcomes.
- Assessing guideline implementation in pre-hospital settings like Emergency Medical Services (EMS) is vital.
Purpose of the Study:
- To evaluate the adherence of Belgrade EMS to current STEMI diagnosis and treatment guidelines.
- To analyze trends in STEMI patient numbers and therapeutic interventions.
- To measure pre-hospital response times for STEMI patients.
Main Methods:
- Retrospective analysis of 2,982 STEMI patients treated by Belgrade EMS.
- Review of applied therapies including MONA (morphine, oxygen, nitroglycerin, aspirin) and dual antiplatelet therapy (aspirin with ticagrelor or clopidogrel).
- Measurement of pre-hospital response times (call to scene, call to hospital arrival) and assessment of direct transport to Percutaneous Coronary Intervention (PCI) units.
Main Results:
- An increasing trend in STEMI patient numbers was observed.
- Significant year-on-year increase in the use of dual antiplatelet therapy, with a notable rise in ticagrelor over clopidogrel.
- Average call-to-scene time was 13.72 minutes, and call-to-hospital arrival time was 52.83 minutes.
Conclusions:
- Belgrade EMS physicians demonstrate adherence to current international and local STEMI management recommendations.
- The study highlights effective implementation of guideline-recommended therapies and timely interventions in a pre-hospital setting.
- Increasing use of ticagrelor signifies evolving treatment protocols in STEMI management within EMS.
Abstract:
The aim of the study was to assess whether current guidelines for diagnosis and treatment of acute ST-elevation myocardial infarction (STEMI) in daily clinical practice are adequately applied in the Belgrade Emergency Medical Service (EMS). A retrospective research included 2,982 STEMI patients who were cared for by EMS teams. Therapy consisting of morphine, oxygen, nitroglycerin and aspirin (MONA) was applied. Dual antiaggregation therapy (aspirin 325 mg + ticagrelor 180 mg or clopidogrel 600 mg) was administered to patients with primary percutaneous coronary intervention (PCI) indicated. With electrocardiographic monitoring included, the patients were transported directly to PCI unit with announcement of the arrival. Response times I-V were measured. There was an increasing trend in the number of STEMI patients. A rapid increase in the use of dual antiaggregation therapy (MONA and clopidogrel or MONA and ticagrelor) was reported from year to year, as well as a dramatic increase in the use of ticagrelor compared to clopidogrel. The time from receiving the call to the arrival on the scene was 13.72 minutes, and the time from receiving the call to hospital arrival was 52.83 minutes. Our physicians care for STEMI patients in accordance with the current international and local recommendations.
Related Concept Videos
01:30Acute Pancreatitis II: Clinical Manifestations and Management
01:17Imaging Studies for Cardiovascular System I:Echocardiography
Indications: Echocardiography is utilized to diagnose heart failure, valve disorders, and myocardial infarction. It also assesses cardiac structures' size, shape, and motion,...
01:20Blood Studies for Cardiovascular System I: Cardiac Biomarkers
The essential diagnostic tools for detecting myocardial necrosis and monitoring individuals suspected of having acute coronary syndrome (ACS) include:
Troponins
Troponins, particularly cardiac troponins I and T, are the most precise and sensitive markers of myocardial injury. They are detectable within 4-6 hours of myocardial injury and remain...
01:26Exercise Stress Test
Exercise stress testing, commonly known as a treadmill test, is a noninvasive procedure used to evaluate cardiovascular function and diagnose heart conditions.
Definition
An exercise stress test measures the heart's response to exertion using a treadmill or stationary bicycle. Chest electrodes record the heart's electrical activity through an ECG, and blood pressure is monitored regularly.
Purposes
01:14SBAR II: Application of SBAR
SBAR Report from a Nurse to a Health Care Provider
S: "Hello, Dr. Smith. This is Jane, RN, from the Med Surg unit. I am calling to tell you about Ms. White in Room 210, who is experiencing increased pain and redness at her incision site. Her recent...