Prehospital thrombolysis in rural emergency room and subsequent transport to a coronary care unit: Ravenna myocardial infarction (RaMI) trial

Coccolini, Stefano; Berti, Gianni; Bosi, Stefano; Pretolani, Marina; Tumiotto, G

doi:10.1016/0167-5273(95)02339-x

Cited by 19 publications

(7 citation statements)

References 37 publications

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“…An Italian study prospectively studied 102 patients with AMI presenting to rural hospitals who were given thrombolytic therapy and subsequently transferred 17-50 km to a metropolitan coronary care unit and compared them with 178 patients presenting directly to a city hospital. 14 The authors recorded no complications during transfer and found that rural patients were given thrombolysis significantly earlier, had less myocardial wall motion abnormality and had improved survival, compared with city hospital patients. 14 The third study prospectively evaluated the effect of t-PA on bleeding complications that arose in 95 patients during and after interhospital helicopter transport; no episodes of cardiac arrest or cardioversion during transport were reported.…”

Section: Discussionmentioning

confidence: 95%

“…14 The authors recorded no complications during transfer and found that rural patients were given thrombolysis significantly earlier, had less myocardial wall motion abnormality and had improved survival, compared with city hospital patients. 14 The third study prospectively evaluated the effect of t-PA on bleeding complications that arose in 95 patients during and after interhospital helicopter transport; no episodes of cardiac arrest or cardioversion during transport were reported. 15 The present study involved more patients than the other three combined and has similar results, demonstrating the low incidence of complications and the high safety of interhospital transport of patients with AMI.…”

Section: Discussionmentioning

confidence: 95%

“…A Medline search using multiple search terms (acute myocardial infarct; acute myocardial infarction; interhospital transfer; interhospital transport; transfer; transport) revealed only three English-language studies since 1990 concerned with complications arising during interhospital transfer of patients in the acute stages of AMI. [13][14][15] All of these studies were of patients given thrombolytic therapy.…”

Section: Discussionmentioning

confidence: 99%

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Safety of interhospital transport of patients with acute myocardial infarction

Hooi

1999

Emergency Medicine

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Objectives: To describe the rate of complications in patients who undergo interhospital transport in the early stages of acute myocardial infarction and to determine whether instability in the emergency department is a predictor of these complications. Methods: A retrospective medical record review of patients with proven acute myocardial infarction transferred from Wyong Emergency Department to Gosford Hospital in the period 1994–96 was performed. Results: Three hundred and twenty‐three patients were transported. Four patients required an unplanned intervention; all four patients suffered hypotension and all had an intravenous nitroglycerin infusion. Three patients required fluid resuscitation and one patient developed supraventricular tachycardia with hypotension, treated by cardioversion. No other complications, cardiac arrest or deaths were recorded. Prior patient instability did not predict three out of four complications during transfer and did not predict any complications in non‐intubated patients. Conclusion: Medical escort of stabilized non‐intubated patients in the early stages of acute myocardial infarction is probably unnecessary. Further prospective studies are needed to determine which patients with acute myocardial infarction can be safely transported without a medical escort.

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Section: Discussionmentioning

confidence: 95%

Section: Discussionmentioning

confidence: 95%

Section: Discussionmentioning

confidence: 99%

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Safety of interhospital transport of patients with acute myocardial infarction

Hooi

1999

Emergency Medicine

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“…Strategies other than moving thrombolysis from the coronary care unit to the emergency department have been examined. These have included instituting ECGs and thrombolysis in the prehospital setting,13 16 fast tracking patients directly to the coronary care unit from general practitioners and ambulances,27 28 and hospitals improving their systems approaches and increasing staff education 2930 In an urban setting such as ours with short transport times, prehospital thrombolysis is unlikely to achieve significant time reductions relative to resource requirements 31.…”

Section: Discussionmentioning

confidence: 99%

Changing the site of delivery of thrombolytic treatment for acute myocardial infarction from the coronary care unit to the emergency department greatly reduces door to needle time

Hourigan

Mountain

Langton

et al. 2000

Heart

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Objective-To quantify the change in door to needle time when delivery of thrombolytic treatment of acute myocardial infarction was changed from the coronary care unit to the emergency department. Design-A comparative observational study using prospectively collected data. Setting-Coronary care unit and emergency department of an Australian teaching hospital. Participants-89 patients receiving thrombolysis in coronary care unit between June 1994 and January 1996, and 100 patients treated in the emergency department between April 1997 and May 1998. Interventions-From April 1997, by agreement between cardiology and emergency medicine, all patients with acute myocardial infarction receiving thrombolysis were treated by emergency physicians in the emergency department. Main outcome measure-Door to needle time measured from time of arrival at the hospital to start of thrombolysis. Other outcomes included pain to needle time and mortality. Results-Median door to needle times were less for patients treated in the emergency department than in the coronary care unit (37 minutes, 95% confidence interval (CI) 33 to 44 v 80 minutes, 95% CI 70 to 89, respectively; p < 0.0001). Door to needle time was under 60 minutes in 83% of emergency department patients and 26% of coronary care unit patients (57% diVerence, 95% CI 45% to 69%; p < 0.0001). Median pain to needle time was less for emergency department patients than for coronary care unit patients (161 minutes, 95% CI 142 to 177 v 195 minutes, 95% CI 180 to 209; p = 0.004); times of less than 90 minutes occurred in 18% of emergency department patients v 1% of coronary care unit patients (17% diVerence, 95% CI 9% to 25%; p < 0.05). Overall mortality was similar in patients treated in the emergency department and the coronary care unit. Conclusions-With a collaborative interdepartmental approach, thrombolytic treatment of acute myocardial infarction was more rapid in the emergency department, without compromising patient safety. This should improve the outcome in patients with infarcts treated with thrombolytic agents.

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“…Durch die Übermittlung der Kardiotokographieparameter ist auch auf Distanz eine Beurteilung des fetalen Zustands möglich. Weitere geprüfte Einsatzmöglichkeiten sind telefonische EKG-Analyse zur Infarktdiagnostik [11,36], Blutdrucküberwachung von Schwangeren [9] oder sonstigen Hypertonikern [18], Monitoring der Blutzuckereinstellung bei erwachsenen und pädiatrischen Diabetikern [ …”

Section: Hno 9•2002 | 819unclassified