Early Thrombolysis for MI Can Be Achieved by Paramedics
NEW YORK (Reuters Health) Jul 03 - There is strong evidence that early treatment with thrombolytic agents improves outcomes after acute MI. Now, findings from a Scottish study indicate that goals to provide such agents within 60 minutes of MI can be achieved by allowing paramedics to initiate pre-hospital thrombolysis. The results, which are published in the July 5th issue of the British Medical Journal, are based on a study of 178 patients who underwent thrombolysis for a suspected ST elevation MI. The patients included 28 from rural areas who received pre-hospital thrombolysis, 43 from rural areas who received in-hospital thrombolysis, and 107 from urban and suburban areas who received in-hospital thrombolysis. The patients in the pre-hospital treatment group were drawn from two postcode regions in Scotland where paramedics where given additional training in how to diagnose and manage acute MI, lead author Dr. David K. Pedley, from the Ninewells Hospital and Medical School in Dundee, Scotland, and colleagues note. The paramedics were given a detailed list of criteria to determine when treatment with tenecteplase should be initiated. To further help in the treatment decision, the ambulances were outfitted with mobile telemetry devices to transmit ECG data to the hospital for analysis. In the pre-hospital treatment group, the median time from first medical contact to initiation of thrombolysis, known as the call to needle time, was 52 minutes. In contrast, the median call to needle time in the rural, in-hospital treatment group was much longer--125 minutes (p < 0.001). The corresponding time in the urban/suburban group was 80 minutes. Sixty-four percent of patients in the pre-hospital treatment group had received thrombolysis within the recommended 60-minute period, while this goal was achieved in only 4% of patients in the comparison group. Ultimately, 89% of patients in the pre-hospital treatment group were confirmed as having an MI, not significantly different that the percentage in the combined in hospital groups-92%. The results indicate that "a system of pre-hospital thrombolysis delivered by paramedics with hospital based decision support is effective in reducing call to needle time in patients from rural areas," the authors conclude. As pre-hospital thrombolysis "evolves, the associated changes in infrastructure and ambulance service will enable further advances in the rapid management of acute MI, including the widespread adoption of facilitated and primary angioplasty in dedicated regional MI centres," Dr. Bernard D. Prendergast, from Wythenshawe Hospital in Manchester, UK, notes in a related editorial. BMJ 2003;327:1-2,22-26. --------------------------------------------------------------------- __________________________________ Do you Yahoo!? SBC Yahoo! DSL - Now only $29.95 per month! http://sbc.yahoo.com --- SMU-L Des textes d'education medicale continue sont disponibles a l'adresse http://www.groupegiroux.com/emc
