TY - JOUR
T1 - Clinical events and treatment in prehospital patients with ST-segment elevation myocardial infarction
AU - Ryan, Damien
AU - Craig, Alan M.
AU - Turner, Linda
AU - Verbeek, P. Richard
PY - 2013
Y1 - 2013
N2 - Background. Little is known about clinically important events and advanced care treatment that patients with ST-segment elevation myocardial infarction (STEMI) encounter in the prehospital setting. Objectives. We sought to determine the proportion of community patients with STEMI who experienced a clinically important event or received advanced care treatment prior to arrival at a designated percutaneous coronary intervention (PCI) laboratory or emergency department (ED). Methods. We reviewed 487 consecutive community patients with STEMI between May 2008 and June 2009. All patients were geographically within a single large "third-service" urban emergency medical services (EMS) system and were transported by paramedics with an advanced care scope of practice. We recorded predefined clinically important events and advanced care treatment that occurred in patients being transported directly to a PCI laboratory or ED (group 1) or interfacility transfer to a PCI laboratory (group 2). Results. One or more clinically important events occurred in 92 of 342 (26.9%) group 1 patients and nine of 145 (6.2%) group 2 patients. The most common were sinus bradycardia, hypotension, and cardiac arrest. Additionally, 33 of 342 (9.6%) group 1 and nine of 145 (6.2%) group 2 patients received one or more advanced care treatments. The most common were administration of morphine and administration of atropine. Eight group 1 patients and three group 2 patients received cardiopulmonary resuscitation (CPR) or defibrillation. Conclusions. Clinically important events and advanced care treatment are common in community STEMI patients undergoing prehospital transport or interfacility transfer to a PCI center. Several patients required CPR or defibrillation. Further research is needed to define the clinical experience of STEMI patients during the out-of-hospital phase and the scope of practice required of EMS providers to safely manage these patients.
AB - Background. Little is known about clinically important events and advanced care treatment that patients with ST-segment elevation myocardial infarction (STEMI) encounter in the prehospital setting. Objectives. We sought to determine the proportion of community patients with STEMI who experienced a clinically important event or received advanced care treatment prior to arrival at a designated percutaneous coronary intervention (PCI) laboratory or emergency department (ED). Methods. We reviewed 487 consecutive community patients with STEMI between May 2008 and June 2009. All patients were geographically within a single large "third-service" urban emergency medical services (EMS) system and were transported by paramedics with an advanced care scope of practice. We recorded predefined clinically important events and advanced care treatment that occurred in patients being transported directly to a PCI laboratory or ED (group 1) or interfacility transfer to a PCI laboratory (group 2). Results. One or more clinically important events occurred in 92 of 342 (26.9%) group 1 patients and nine of 145 (6.2%) group 2 patients. The most common were sinus bradycardia, hypotension, and cardiac arrest. Additionally, 33 of 342 (9.6%) group 1 and nine of 145 (6.2%) group 2 patients received one or more advanced care treatments. The most common were administration of morphine and administration of atropine. Eight group 1 patients and three group 2 patients received cardiopulmonary resuscitation (CPR) or defibrillation. Conclusions. Clinically important events and advanced care treatment are common in community STEMI patients undergoing prehospital transport or interfacility transfer to a PCI center. Several patients required CPR or defibrillation. Further research is needed to define the clinical experience of STEMI patients during the out-of-hospital phase and the scope of practice required of EMS providers to safely manage these patients.
KW - myocardial infarction; complications; emergency medical services; emergency treatment
UR - http://www.scopus.com/inward/record.url?scp=84874615808&partnerID=8YFLogxK
U2 - 10.3109/10903127.2012.744783
DO - 10.3109/10903127.2012.744783
M3 - Article
C2 - 23281589
AN - SCOPUS:84874615808
SN - 1090-3127
VL - 17
SP - 181
EP - 186
JO - Prehospital Emergency Care
JF - Prehospital Emergency Care
IS - 2
ER -