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).
Cohort (n=344)
Yes
Does direct field referral by trained paramedics reduce door-to-balloon time in STEMI patients compared to emergency department referral?
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.
Absolute Event Rate: 79.7% vs 11.9%
p-value: p=<0.001
BACKGROUND: If primary percutaneous coronary intervention (PCI) is performed promptly, the procedure is superior to fibrinolysis in restoring flow to the infarct-related artery in patients with ST-segment elevation myocardial infarction. The benchmark for a timely PCI intervention has become a door-to-balloon time of less than 90 minutes. Whether regional strategies can be developed to achieve this goal is uncertain. METHODS: We developed an integrated-metropolitan-area approach in which all patients with ST-segment elevation myocardial infarction were referred to a specialized center for primary PCI. We sought to determine whether there was a difference in door-to-balloon times between patients who were referred directly from the field by paramedics trained in the interpretation of electrocardiograms and patients who were referred by emergency department physicians. RESULTS: Between May 1, 2005, and April 30, 2006, a total of 344 consecutive patients with ST-segment elevation myocardial infarction were referred for primary PCI: 135 directly from the field and 209 from emergency departments. Primary PCI was performed in 93.6% of patients. The median door-to-balloon time was shorter in patients referred from the field (69 minutes; interquartile range, 43 to 87) than in patients needing interhospital transfer (123 minutes; interquartile range, 101 to 153; P<0.001). Door-to-balloon times of less than 90 minutes were achieved in 79.7% of patients who were transferred from the field and in 11.9% of those transferred from emergency departments (P<0.001). CONCLUSIONS: Guideline door-to-balloon-times were more often achieved when trained paramedics independently triaged and transported patients directly to a designated primary PCI center than when patients were referred from emergency departments.
May et al. (Wed,) 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).
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