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Updated: Aug 9, 2026
Prehospital Thrombolysis: A Manual from Berlin
Published on: November 26, 2013
[Delayed thrombolytic administration in myocardial infarction;]
F J Ochoa Gómez1, J M Carpintero Escudero, E Ramalle-Gómara
1Unidad de Cuidados Intensivos, Complejo Hospitalario San Millán-San Pedro, INSALUD, Logroño.
Insights
Consulting a doctor before hospital arrival delays critical care unit admission for acute myocardial infarction (AMI) patients. This delay also reduces their chances of receiving timely thrombolytic therapy.
Area of Science:
- Cardiology
- Emergency Medicine
- Public Health
Background:
- Acute myocardial infarction (AMI) management requires timely intervention.
- Pre-hospital care pathways can influence treatment timeliness.
- Understanding the impact of extra-hospitalary physician consultations on AMI patient outcomes is crucial.
Purpose of the Study:
- To determine if consulting an extra-hospitalary physician before hospital arrival delays critical care unit (CCU) admission for AMI patients.
- To assess if this pre-hospital consultation reduces the likelihood of receiving early thrombolytic therapy.
Main Methods:
- A descriptive study analyzed 118 patients diagnosed with AMI in 1995.
- Data collected included demographics, previous AMI history, extra-hospitalary physician consultation, and time to CCU admission.
- Statistical analyses included proportion comparisons, t-tests, Mann-Whitney U-test, and multiple logistic regression.
Main Results:
- Patients consulting an extra-hospitalary physician experienced a 100-minute delay in hospital arrival and a 124-minute delay in CCU admission.
- These patients had a 3.3 times higher risk of CCU admission after 3 hours from symptom onset (OR: 3.3, 95% CI: 1.2-9.2).
- Delay to hospital arrival was the primary reason for exclusion from early thrombolytic treatment.
Conclusions:
- Consultation with an extra-hospitalary physician before hospital arrival is associated with delayed CCU admission for AMI patients.
- These patients have a significantly lower probability of receiving early thrombolytic therapy within the critical first 3 hours.
Background:
The aim of the study is to know whether the patients with acute myocardial infarction (AMI) who consulted an extrahospitalary physician before the hospital arrival delayed their admission to the critical care unit (CCU), and whether their probability to receive early thrombolytic therapy was smaller than that of the patients who cam directly to hospital.
Patients And Methods:
A descriptive study in patients with AMI was performed during 1995. The following variables were studied: age, sex, town of residence, previous AMI, consultation to an extrahospitalary physician, delay time in the admission to the CCU, and whether thrombolytic treatment was performed. Comparison of proportions, Student-Fisher t-test, or Mann-Whitney U-test were used, according to the case. A multiple logistic regression was used to study the independent effect of the previous consult to an extrahospitalary physician on the chance for early thrombolytic treatment.
Results:
A hundred and eighteen patients (79.7% males) were studied. The mean age was 63 years-old. Nine point five per cent of the patients had suffered a previous AMI and 54.2% received thrombolytic treatment. Delay to hospital arrival was the main exclusion reason to receive this treatment. The mean age of patients who consulted an extrahospitalary physician (n = 69) was 5 years older, their hospital arrival were 100 min later (difference of medians) (p < 0.001), were admitted to the CCU 124 min later (p < 0.02) and ran a higher risk to arrive to CCU after 3 hours from the onset of symptoms (odds ratio [OR]: 3.3; confidence interval [IC] 95%: 1.2 to 9.2) than those who cam directly to hospital.
Conclusions:
The patients with AMI who consult an extrahospitalary physician delay their admission to the CCU and have a less chance to receive early thrombolytic therapy in the first 3 hours of evolution.
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