Key result
Paramedic prehospital thrombolysis is linked to ~73-minute faster call-to-needle time versus in-hospital care.
Why the study?
Evaluation of a prehospital thrombolysis system delivered by paramedics was needed to assess its ability to meet national targets for acute myocardial infarction management.
Cohort (n=201)
No
Effect estimate: Median time saved 73 minutes
Absolute Event Rate: 52% vs 125%
p-value: p=< 0.001
Prehospital paramedic thrombolysis was associated with 73-minute shorter call-to-needle times in rural STEMI; leaves open whether outcomes improve versus contemporary reperfusion strategies.
OBJECTIVES: To evaluate a system of prehospital thrombolysis, delivered by paramedics, in meeting the national service framework's targets for the management of acute myocardial infarction. DESIGN: Prospective observational cohort study comparing patients with suspected acute myocardial infarction considered for thrombolysis in the prehospital environment with patients treated in hospital. SETTING: The catchment area of a large teaching hospital, including urban and rural areas. PARTICIPANTS: 201 patients presenting concurrently over a 12 month period who had changes to the electrocardiogram that were diagnostic of acute myocardial infarction or who received thrombolysis for suspected acute myocardial infarction. MAIN OUTCOME MEASURES: Time from first medical contact to initiation of thrombolysis (call to needle time), number of patients given thrombolysis appropriately, and all cause mortality in hospital. RESULTS: The median call to needle time for patients treated before arriving in hospital (n=28) was 52 (95% confidence interval 41 to 62) minutes. Patients from similar rural areas who were treated in hospital (n=43) had a median time of 125 (104 to 140) minutes. This represents a median time saved of 73 minutes (P < 0.001). Sixty minutes after medical contact 64% of patients (18/28) treated before arrival in hospital had received thrombolysis; this compares with 4% of patients (2/43) in a cohort from similar areas. Median call to needle time for patients from urban areas (n=107) was 80 (78 to 93) minutes. Myocardial infarction was confirmed in 89% of patients (25/28) who had received prehospital thrombolysis; this compares with 92% (138/150) in the two groups of patients receiving thrombolysis in hospital. CONCLUSIONS: Thrombolysis delivered by paramedics with support from the base hospital can meet the national targets for early thrombolysis. The system has been shown to work well and can be introduced without delay.
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David K Pedley (2003) conducted a cohort in Acute myocardial infarction (n=201). Prehospital thrombolysis delivered by paramedics vs. Thrombolysis in hospital was evaluated on Time from first medical contact to initiation of thrombolysis (call to needle time) (Median time saved 73 minutes, p=< 0.001). Prehospital thrombolysis delivered by paramedics saved a median of 73 minutes in call-to-needle time compared to in-hospital treatment for rural patients (52 vs 125 minutes; P<0.001).
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