Abstract 2271: Implementation of a Team-Based Approach for the Management of ST Elevation Myocardial Infarction Improves Symptom Onset to Treatment Time
Background: In patients with ST elevation MI (STEMI) primary percutaneous coronary intervention (PCI) is limited by prolonged time to reperfusion from symptom onset. Pre-hospital thrombolytics followed by emergent PCI has the potential to significantly reduce symptom onset to reperfusion times.
Methods: We developed a system which incorporates EMS evaluation of patients for STEMI with transmission of 12 lead ECGs to the Level I CV emergency center (EC) for review by the EC attending. Patients meeting inclusion criteria received in-field 1/2 dose thrombolytic therapy (reteplase), and were transported for emergency coronary intervention, while the interventional team was mobilized. The number of EMS units participating was expanded progressively using a “train the trainer” model over the initial 18 months.
Results: From October 2003 to April 2006 enrollment per quarter increased from 3 to 19 as the number of EMS units trained increased from 5 to 58. Pre- hospital PCI team notification reduced the JCAHO reportable door to balloon times for all patients from 219 to 53 min (as low as 12 min). These measures combined to reduce the symptom onset to treatment time from 221min (historical controls) to 122min (facilitated PCI, p < 0.0023)
Conclusions: Successful implementation of a pre-hospital reperfusion strategy requires close cooperation between healthcare providers. This team approach provides the infrastructure to decrease door to balloon and symptom onset to treatment times. Once community, political, ethical, and technical issues are methodically addressed, the healthcare benefits to the local community can be dramatically improved.