Very Rapid Treatment of ST-Segment–Elevation Myocardial Infarction
| Autor: | Thomas A. Wiberg, Margaret M. Beahrs, Peter K. Rusterholz, Brian D. Mahoney, Patrick T. Koller, Jay J. Westwater, Thomas E. Raya, Charles F. Alexander, Thomas A. Biggs, Sara T. Murray, Uma S. Valeti, Kenneth W. Baran, Kathryn A. Kamrowski, Victor H. Tschida |
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| Rok vydání: | 2010 |
| Předmět: |
Patient Transfer
Emergency Medical Services Acute coronary syndrome Health Personnel medicine.medical_treatment Myocardial Infarction medicine Emergency medical services Humans cardiovascular diseases Myocardial infarction Physician's Role Brugada Syndrome Cardiac catheterization business.industry ST elevation Angioplasty Percutaneous coronary intervention American Heart Association Emergency department medicine.disease Survival Analysis Competency-Based Education United States surgical procedures operative Practice Guidelines as Topic Conventional PCI Guideline Adherence Medical emergency Cardiology and Cardiovascular Medicine business Program Evaluation |
| Zdroj: | Circulation: Cardiovascular Quality and Outcomes. 3:431-437 |
| ISSN: | 1941-7705 1941-7713 |
| DOI: | 10.1161/circoutcomes.110.942631 |
| Popis: | Prehospital ECG (PH-ECG) has been identified as a strategy to help reduce door-to-balloon (D2B) time during emergency treatment with percutaneous coronary intervention (PCI) for patients with ST-elevation myocardial infarction (STEMI).1 National Registry of Myocardial Infarction data from 2000–2002 suggest utilization rates of PH-ECG of 7000 patients with acute coronary syndrome transported by emergency medical services (EMS) during 2007 found PH-ECG utilization rates of 27.4%.3 Among this cohort, D2B times were significantly shorter than the cohort of patients without PH-ECG, and there was a trend toward lower in-hospital mortality. Systems of care that have incorporated PH-ECGs into a citywide or region-wide strategy have demonstrated a significant reduction in D2B times, usually by triaging patients in the prehospital setting, bypassing non-PCI-capable hospitals, and transporting patients directly to a designated STEMI receiving center (SRC) capable of providing primary PCI.4,5 Rapid and accurate interpretation of the PH-ECG is a critical step in the process of incorporating PH-ECG into systems of care for acute STEMI. Different models for interpretation of PH-ECGs have been described, including computer algorithm interpretation, wireless transmission to designated centers for physician interpretation, and direct paramedic interpretation.1 Previous studies demonstrated that trained EMS personnel can reliably identify STEMI on the PH-ECG.6,7 We initiated a program to evaluate a novel strategy to reduce D2B time for patients with STEMI who undergo PCI. The intent was to expedite prehospital triage and to reduce emergency department (ED) delays to treatment with PCI for patients with acute STEMI. We empowered EMS personnel to interpret the PH-ECG in the prehospital setting and then to activate the cardiac catheterization laboratory (CV laboratory) staff before transporting the patient to … |
| Databáze: | OpenAIRE |
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