Pre-hospital versus in-hospital thrombolysis for ST-elevation myocardial infarction

McCaul, Michael; Lourens, Andrit; Kredo, Tamara

doi:10.1002/14651858.cd010191.pub2

Cited by 22 publications

(20 citation statements)

References 81 publications

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“…Although primary PCI is the gold standard, guideline recommended treatment for STEMI, we suggest that patients could undergo fibrinolysis if the anticipated time from FMC to balloon inflation is greater than 90 min . In these patients, PHT effectively reduces time to treatment and total ischaemic time, based on studies conducted in higher income countries . In settings where it can be safely and correctly administered by trained staff and primary PCI is not timely available, PHT is an appropriate and evidence‐based intervention.…”

Section: Discussionmentioning

confidence: 99%

Pre‐hospital thrombolysis for ST‐segment elevation myocardial infarction in regional Australia: long‐term follow up

Khan

Williams

Al‐Omary

et al. 2020

Internal Medicine Journal

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Background Delivering reperfusion therapy to patients with ST‐segment elevation myocardial infarction (STEMI) in regional areas without access to tertiary cardiology care remains challenging. The systems of care in Hunter New England Health, New South Wales, Australia (area covered = 130 000 km2) to provide reperfusion to patients with STEMI involve a 12‐lead electrocardiogram in the ambulance, discussion between cardiologist and paramedic, followed by pre‐hospital thrombolysis (PHT) delivered in ambulance to appropriate patients >60 min from the cardiac catheterisation laboratories. Patients who can access the cardiac catheterisation laboratories within 60 min are treated with primary percutaneous coronary intervention (PCI). Aims We have previously reported excellent 12‐month outcomes for patients receiving PHT and the aim of the current analysis is to look at the long term outcomes. Methods We assessed long‐term all‐cause mortality and major adverse cardiovascular events of STEMI patients undergoing PHT in our health district from August 2008 to August 2013 and compared with the primary PCI group. Results One hundred and fifty (mean age: 62 ± 13 years, males: 76%, n = 114) patients were administered PHT and 334 patients (mean age: 65 ± 13 years, males: 75%, n = 251) underwent primary PCI during the study period. During a median follow up of 6.2 years (interquartile range: 4.8–7.4 years) all‐cause mortality was 16% and 19% in the PHT and primary PCI groups respectively (P = 0.4). Conclusion Our real‐world experience shows that PHT followed by early transfer to a primary PCI‐capable centre is an effective reperfusion strategy, with comparable results to primary PCI, and mortality benefits are sustained to more than 6 years.

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Section: Discussionmentioning

confidence: 99%

Pre‐hospital thrombolysis for ST‐segment elevation myocardial infarction in regional Australia: long‐term follow up

Khan

Williams

Al‐Omary

et al. 2020

Internal Medicine Journal

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“…The Cochrane Library also demonstrates the limited utility of the evidence to inform practice. A review of the use of aminophylline for cardiac arrest found five trials with no survivors 3 . A report on prehospital thrombolysis showed a reduction in time to thrombolysis, but limited evidence of its safety or on its long‐term outcomes 4 .…”

Section: Relating Evidence To Practice In Uncontrolled Environmentsmentioning

confidence: 99%

Paramedics and scope of practice

FitzGerald

2015

Medical Journal of Australia

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“…In some studies, prehospital administration of thrombolytics for myocardial infarction (MI) has been shown to improve survival [14]. Unfortunately, this is not a common practice in the United States.…”

Section: Als Interventions and Survivalmentioning

confidence: 99%

Background and Advantages of a Tiered EMS Response in a Large, Fire-Based EMS Model

Persse¹

2015

Health Care Current Reviews

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The uniform response (one that includes a paramedic) provides some advantages, most notably that there is always an advanced AbstractEmergency medical services (EMS) systems vary across country, state, and even county lines. Which model provides the most effective and safe care has been hotly debated. Some models employ a fire-based EMS response, whereas others are privately funded and are completely separate from other public responders. Response can be uniform or tiered, which means that either ALS units respond to every call or calls are triaged based on their severity and units are dispatched accordingly. This requires a sophisticated dispatch algorithm that screens for emergencies of highest priority. Persse et al. sought to determine the difference in survival in out-of-hospital ventricular fibrillation arrest between a tiered response EMS model and an all advanced life support (ALS) response model within the same system.

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Pre-hospital versus in-hospital thrombolysis for ST-elevation myocardial infarction

Abstract: Pre-hospital versus in-hospital thrombolysis for ST-elevation myocardial infarction (Review)

Cited by 22 publications

References 81 publications

Pre‐hospital thrombolysis for ST‐segment elevation myocardial infarction in regional Australia: long‐term follow up

Pre‐hospital thrombolysis for ST‐segment elevation myocardial infarction in regional Australia: long‐term follow up

Paramedics and scope of practice

Background and Advantages of a Tiered EMS Response in a Large, Fire-Based EMS Model

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