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Inpharma 1395 - 12 Jul 2003
than 60 minutes was met in 95% of cases.Prehospital thrombolysis timeThe researchers suggest that their data indicate thatsaving for acute MI autonomous paramedic prehospital thrombolysis is
both feasible and safe and improves call to needle times.Prehospital thrombolysis administered by paramedics1. Pedley DK, et al. Prospective observational cohort study of time saved bycan meet UK national targets for early treatment of acute
prehospital thrombolysis for ST elevation myocardial infarction delivered bymyocardial infarction (MI), report researchers fromparamedics. BMJ 327: 22-26, 5 Jul 2003.
Scotland.12. Prendergast BD. Prehospital thrombolysis. BMJ 327: 1-2, 5 Jul 2003.3. Keeling P, et al. Safety and feasibility of prehospital thrombolysis carried out byThey determined the effectiveness of a system in
paramedics. BMJ 327: 27-28, 5 Jul 2003.which prehospital thrombolysis is delivered by800969029
paramedics in ambulances and clinical decision supportis provided by the emergency department of a basehospital via a mobile telemetry link. The patients weredivided into three groups: those presenting within anapproximately 15km radius of the base hospital whowere considered for conventional hospital thrombolysis(group 1), those presenting from outside the 15kmradius who were considered for conventional hospitalthrombolysis (group 2), and those from outside the15km radius who were considered for prehospitalthrombolysis with tenecteplase (group 3).
A total of 282 patients were admitted to the basehospital with a diagnosis of MI, or received thrombolysisfor a suspected MI, over the study period. Diagnosticchanges on the electrocardiogram were observed in 201patients at presentation; 178 patients receivedthrombolytic agents. Myocardial infarction wasconfirmed in 89% of patients who received prehospitalthrombolysis and in 92% of patients who receivedconventional hospital-based thrombolysis. The mediancall to needle time, defined as the time from first medicalcontact to the initiation of thrombolysis, was 52 minutesamong patients in group 3, compared with 80 minutesamong patients in group 1 and 125 minutes amongpatients in group 2. The administration of prehospitalthrombolysis therefore resulted in a median time savingof 73 minutes, compared with patients from rural areas,and of 28 minutes, compared with patients from urbanareas.
"Given that our data show a time saving of more thanone hour in the prehospital group, we might expect twoextra lives saved per 100 patients treated", say theresearchers.
In an accompanying editorial, Dr Bernard Prendergastfrom the Wythenshawe Hospital, Manchester, UK,comments that "in the immediate term, prehospitalthrombolysis should be strongly considered in ruralcommunities and congested urban areas where transferto hospital is likely to be delayed."2
A second study, conducted by researchers from theUK, evaluated the feasibility of autonomous prehospitalthrombolysis.3
During the one-year study, electrocardiograms ofpatients with emergency chest pain were transmitted toa base hospital via telemetry and reviewed by aspecialist emergency department physician. Theattendant paramedics recorded data on the diagnosis ofphysicians along with their own hypothetical decision totreat and the timing of all events. Data were available for660 patients.
An overall analysis revealed that based on thehypothetical decisions of the paramedics, 84 patientswho presented with emergency chest pain experiencedan ST elevation acute MI. Physician diagnoses confirmedthat 118 patients experienced an acute MI. The mediancall to potential needle time, defined as the timebetween medical contact and the paramedics decision,was 28 minutes. The goal of call to needle time in less
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Inpharma 12 Jul 2003 No. 13951173-8324/10/1395-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved