A Citywide Protocol for Primary PCI in ST-Segment Elevation Myocardial Infarction
Key result
Direct triage and transport of STEMI patients by trained paramedics achieved door-to-balloon times <90 minutes in 79.7% of cases compared to 11.9% for emergency department referrals (P<0.001).
Why the study?
Does direct field referral by trained paramedics reduce door-to-balloon time in STEMI patients compared to emergency department referral?
Population
344 consecutive patients with ST-segment elevation myocardial infarction referred for primary percutaneous…
Comparison
Direct referral from the field by paramedics… vs Referral from emergency departments to the…
Design
Cohort
Authors
Discussion
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Member takes
Implication
Supports prehospital paramedic triage in STEMI systems; leaves open need for randomized outcome confirmation.
Study Design
Type
Cohort (n=344)
Multicenter
Yes
Structured PICO
Does direct field referral by trained paramedics reduce door-to-balloon time in STEMI patients compared to emergency department referral?
P
Population
344 consecutive patients with ST-segment elevation myocardial infarction (STEMI) referred for primary percutaneous coronary intervention (PCI)
I
Intervention
Direct referral from the field by paramedics trained in the interpretation of electrocardiograms to a specialized primary PCI center
C
Comparator
Referral from emergency departments (interhospital transfer) to the primary PCI center
O
Outcome
Door-to-balloon time and proportion of patients achieving door-to-balloon time of less than 90 minutessurrogate
Main Result
Absolute Event Rate: 79.7% vs 11.9%
p-value: p=<0.001
Direct field triage and transport of STEMI patients by trained paramedics significantly increases the likelihood of achieving guideline-directed door-to-balloon times compared to interhospital transfer.
Cite This Study
May et al. (2008) conducted a cohort in ST-segment elevation myocardial infarction (n=344). Direct referral from the field by trained paramedics vs. Referral from emergency departments (interhospital transfer) was evaluated on Door-to-balloon time of less than 90 minutes (p=<0.001). Direct triage and transport of STEMI patients by trained paramedics achieved door-to-balloon times <90 minutes in 79.7% of cases compared to 11.9% for emergency department referrals (P<0.001).