Abstract 16418: Standardized STEMI Alert Protocols and Interfacility Transfer Guidelines Optimize STEMI Reperfusion Times
Introduction: Current AHA STEMI guidelines indicate a door to PCI time of 90 minutes and a door to fibrinolysis time of 30 minutes. These intervals have significant implications for hospitals that transfer STEMI patients for emergent PCI.
Purpose: We evaluated the impact of a standardized “STEMI ALERT” program initiated at a STEMI referral hospital that utilizes immediate air transport and PCI lab activation at the receiving PCI center (46 miles away) prior to transfer as components of an optimized STEMI treatment approach.
Methods: This study was conducted during calendar year 2010 at two affiliated institutions; a non-PCI-capable sending hospital and a PCI-capable receiving hospital. A standardized STEMI ALERT process based on Project UPSTART® was implemented at the transferring institution to guide initial STEMI management and decision making. This approach used provider checklists and data collection sheets to guide initial management, including auto-launch of air EMS if immediately available. Data collected included total time to reperfusion for all STEMI patients. Outcome measures included the interval from initial hospital contact to final PCI reperfusion. Transfer STEMI ALERTS were compared with non-transfer STEMI ALERTS at the receiving facility.
Results: Seventy-six STEMI patients were studied - 29 transfers from the outside facility and 47 direct presentations. Patients suffering cardiac arrest after arrival were excluded (3 at the transferring center; 4 at the PCI-center), as were 5 patients given fibrinolysis at outside hospital due to anticipated delays. The mean time from arrival at the outside hospital to reperfusion at the PCI center was 102 minutes (range 69-152). The mean PCI door-to-balloon interval was 24 minutes for interfacility transfers and 57 minutes for direct presentations (p<0.05). Eight of 21 (38%) transfers and 42 of 43 (98%) direct presenters met current 90-minute reperfusion guidelines.
Conclusions: Standardized STEMI ALERT protocols involving interfacility transfers that are executed within efficient systems of care can dramatically shorten total reperfusion times in acute STEMI but substantial variability remains, indicating the need for independent decision making on a case-by-case basis when necessary.
- © 2011 by American Heart Association, Inc.