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Postconditioning with Lactate-enriched Blood for Cardioprotection in ST-segment Elevation Myocardial Infarction
Published on: May 28, 2019
Association of pre-hospital shock team implementation with outcomes in ST-segment elevation myocardial infarction
Abdulrahman Arabi1, Mhd Baraa Habib1, Mohamed Salah Abdelghani1
1Cardiology Department, Heart Hospital, Hamad Medical Corporation, Doha, Qatar.
Insights
Activating a pre-hospital shock team for ST-segment elevation myocardial infarction (STEMI) significantly reduced early and overall hospital mortality. This proactive approach improves outcomes for patients experiencing cardiogenic shock.
Area of Science:
- Cardiology
- Emergency Medicine
- Critical Care
Background:
- Cardiogenic shock (CS) in ST-elevation myocardial infarction (STEMI) carries a high mortality risk.
- In-hospital shock teams improve outcomes, but pre-hospital activation is less studied.
Purpose of the Study:
- To evaluate the impact of a pre-hospital shock team on mortality rates in STEMI patients.
Main Methods:
- A pre-hospital shock team was implemented at a high-volume PCI center.
- The multidisciplinary team included ED physicians, intensivists, interventional cardiologists, anesthesiologists, and ECMO specialists.
- Mortality rates were compared 18 months pre- and post-implementation for STEMI patients meeting shock criteria.
Main Results:
- STEMI patient volume increased post-implementation.
- Early hospital mortality decreased from 1.2% to 0.3% (p=0.03).
- Overall hospital mortality decreased from 2.1% to 3.3% (p=0.02).
Conclusions:
- Pre-hospital shock team activation is associated with significant reductions in STEMI-related mortality.
- This strategy demonstrates a potential to improve survival rates for critically ill STEMI patients.
Background:
Cardiogenic shock (CS) complicating ST-segment elevation myocardial infarction (STEMI) is associated with high mortality rates. While in-hospital shock teams have shown benefits, the impact of pre-hospital shock team activation remains underexplored.
Methods:
In July 2022, our high-volume primary percutaneous coronary intervention (PPCI) center serving the entire state population implemented a pre-hospital shock team. This multidisciplinary team comprises an emergency department physician, cardiac intensivist, interventional cardiologist, cardiac anesthesiologist, and extracorporeal membrane oxygenation (ECMO) specialists. Activation criteria include hypotension, tachycardia or bradycardia, acute heart failure, significant ST-elevation, ventricular arrhythmias, or elevated lactic acid levels. We compared mortality rates 18 months before and after implementation.
Results:
Before implementation, 1,605 STEMI patients were admitted, compared to 1,735 after implementation. Of these, 217 (12%) met shock team activation criteria. Early Hospital mortality (in ED and in Cath lab) and Overall-hospital mortality rates significantly declined following implementation (1.2% vs. 0.3%, p = 0.03; and 2.1% vs. 3.3%, p = 0.02, respectively).
Conclusion:
This study suggests that pre-hospital shock team implementation is associated with a significant reduction in STEMI mortality.
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