Abstract 1991: Paramedic Prehospital Cath Lab Activation for STEMI, Without ECG Transmission, Dramatically Reduces Door To Balloon Time
BACKGROUND: By using a team-based approach, and ED staff activating the cath lab, our mean Door-Balloon Time (DBT) was <90 min.
OBJECTIVE: Further improve our DBT through paramedic prehospital cath lab activation.
METHODS: Since 2001 all pts transported by our EMS, with symptoms of MI, had Pre-hospital EKG. In April 2005, we started this protocol (with no other change in MI program): EMS transporting pts with Chest Pain (CP)and a Zoll® EKG reads “Acute MI”, EMS may activate the cath lab from the scene without MD involvement. For all EMS transported pts from Jan 2004 to Jan 2007, we analyzed demographics, symptoms, Zoll interpretation, door-to-EKG-time (DtEKG had a negative value for prehospital EKG), and DBT. We compared the two groups (G), before (B) and after (A) protocol change. Pts without either chest pain or a diagnostic EKG were excluded. Stats by Kruskal Wallis.
RESULTS: 104 patients with STEMI transported in that period. 36 were excluded: 26 had no chest pain (14 cardiac arrest), 8 with a non-diagnostic Zoll EKG and 2 others. Of 68 eligible patients (65% of 104), 24 were before starting the protocol (Before Group, BG) and 44 were after (After Group, AG). Baseline characteristics of the groups were equivalent. Of 44 pts in the after protocol group (AG), 36 had prehospital activation; and 8 pts did not have prehospital cath lab activation because of transport by other EMS or because of protocol violations. 5 of these 8 were within the first 6 months of use of the protocol. See table⇓ for results. There were 3 false activations: 2 protocol violations (EKG’s interpreted as STEMI by paramedic while not by Zoll) and one false activation because Zoll read early repolarization as Acute MI.
CONCLUSION: Paramedic pre-hospital cath lab activation, without EKG transmission, dramatically reduces DBT for patients who have both CP and a Zoll-diagnostic EKG. Most STEMI patients meet these eligibility requirements. Larger prospective studies would be necessary to demonstrate mortality benefit.