Abstract 3462: Pre-hospital 12 Lead ECG with Activation of Catheterization Lab Team Significantly Reduces Door to Balloon Time in STEMI
Background: Reducing door to balloon time in primary PCI for ST Elevation MI is a quality priority. Paramedic performed pre-hospital 12 lead ECG and activation of the cath lab may allow for significant improvements in door to balloon time. In 2005 such a system was implemented in San Diego. The identification of STEMI relied on an automatic computer algorithm.
Methods: Data was prospectively collected on all STEMI patients identified at UCSD Medical Center during the first 9 months since implementation of pre-hospital ECG. We compared door to balloon time as well as door to cath lab time for patients identified pre-hospital to patients identified in the ED, both during the same time period as well as historical controls from the year prior to initiation of pre-hospital ECG program.
Results: Pre-hospital activation reduced door to balloon time by half (p<0.001 vs. both 2004 and 2005); Specificity of the algorithm was 75%. Door to balloon time of <90 minutes was achieved in 85% for prehospital group compared to 10% of ED identified patients in 2004 and 15% in 2005 (p<0.001 vs. both 2004 and 2005).
Conclusion: Implementation of a paramedic pre-hospital ECG program with activation of the cath lab team can significantly improve door to balloon time in STEMI patients.