Abstract 8885: Paramedic Contact to Balloon in Less Than 90 Minutes: a Successful Strategy for STEMI Bypass to Primary PCI in a Canadian Emergency Medical System
Introduction: Few systems worldwide have achieved the benchmark of less than 90 minutes from time of first medical contact to balloon inflation when using emergency medical services (EMS) contact time as first medical contact. We describe a successful EMS systems approach using a combination of paramedic and 12-lead electrocardiogram (ECG) software interpretation to activate a ST elevation myocardial infarction (STEMI) bypass protocol.
Hypothesis: The proportion of STEMI patients for whom EMS contact to balloon was less than 90 minutes increases significantly after implementation of a paramedic activated STEMI bypass protocol.
Methods: We conducted a ”before and after” observational cohort study over a 24-month consecutive period ending December 31, 2009. Included were all patients diagnosed with STEMI by paramedics trained in ECG acquisition and interpretation and transported by EMS. Advanced Emergency Department (ED) notification by paramedics of a STEMI patient occurred in the ”before” phase of the study and patients stopped in the emergency department (ED) of the receiving center. In the 12 month ”after phase” the paramedics activated a STEMI bypass protocol where STEMI patients were transported directly to the percutaneous coronary intervention suite bypassing the local hospital EDs. ECG transmission did not occur in either phase of the study.
Results: We compared times for 95 STEMI patients in the ”before” phase with times for 80 STEMI patients in the ”after” phase. The proportion for whom E2B was less than 90 minutes increased from 28.4% before to 91.3% after (χ2 = 70, p < .001). Median E2B times decreased from 107 minutes (Interquartile range [IQR] = 30) before to 70 minutes (IQR = 24) after. Median time from arrival at hospital door to balloon (D2B) decreased from 83.0 minutes (IQR = 34) before to 34.5 minutes (IQR = 19) after. Median transport time to hospital (E2D) increased from 21.0 minutes (IQR = 29) before to 30.5 minutes (IQR = 17) after. Median differences between phases were significant at p < .001 (Mann-Whitney U tests).
Conclusions: The proportion of patients with E2B times less then 90 minutes and PCI hospital D2B times were significantly improved through the implementation of a paramedic activated STEMI bypass protocol.
- © 2010 by American Heart Association, Inc.