EMS, Department of Emergency Medicine, Yale University School of Medicine, New Haven, Connecticut 06519, USA.
Prehosp Emerg Care. 2010 Apr-Jun;14(2):153-8. doi: 10.3109/10903120903537213.
Prompt reperfusion in ST-segment elevation myocardial infarction (STEMI) saves lives. Although studies have shown that paramedics can reliably interpret STEMI on prehospital 12-lead electrocardiograms (p12ECGs), prehospital activation of the cardiac catheterization laboratory by emergency medical services (EMS) has not yet gained widespread acceptance.
To quantify the potential reduction in time to percutaneous coronary intervention (PCI) by early prehospital activation of the cardiac catheterization laboratory in STEMI.
This prospective, observational study enrolled all patients diagnosed with STEMI by paramedics in a mid-sized regional EMS system. Patients were enrolled if: 1) the paramedic interpreted STEMI on the p12ECG, 2) the Acute Cardiac Ischemia Time-Insensitive Predictive Instrument (ACI-TIPI) score was 75% or greater, and 3) the patient was transported to either of two area PCI centers. Data recorded included the time of initial EMS "STEMI alert" from the scene, time of arrival at the emergency department (ED), and time of actual catheterization laboratory activation by the ED physician, all using synchronized clocks. The primary outcome measure was the time difference between the STEMI alert and the actual activation (i.e., potential time savings). The false-positive rate (patients incorrectly diagnosed with STEMI by paramedics) was also calculated and compared with a locally accepted false-positive rate of 10%.
Twelve patients were enrolled prior to early termination of the study. The mean and median potential time reductions were 15 and 11 minutes, respectively (range 7-29 minutes). There was one false STEMI alert (8.3% false-positive rate) for a patient with a right bundle branch block who subsequently had a non-ST-segment elevation myocardial infarction. The study was terminated when our cardiologists adopted a prehospital catheterization laboratory activation protocol based on our initial data.
Important reductions in time to reperfusion seem possible by activation of the catheterization laboratory by EMS from the scene, with an acceptably low false-positive rate in this small sample. This type of clinical research can inform multidisciplinary policies and bring about meaningful clinical practice changes.
ST 段抬高型心肌梗死（STEMI）的及时再灌注可挽救生命。虽然研究表明，护理人员可以在院前 12 导联心电图（p12ECG）上可靠地解读 STEMI，但紧急医疗服务（EMS）对心脏导管实验室的院前激活尚未得到广泛认可。
通过在 STEMI 中尽早激活院前心脏导管实验室，量化经皮冠状动脉介入治疗（PCI）时间的潜在缩短。
这项前瞻性、观察性研究纳入了在中型地区 EMS 系统中由护理人员诊断为 STEMI 的所有患者。如果符合以下条件，则纳入患者：1）护理人员在 p12ECG 上解读为 STEMI，2）急性心脏缺血时间不敏感预测工具（ACI-TIPI）评分≥75%，以及 3）患者被转运至两个区域 PCI 中心之一。记录的数据包括从现场发出初始 EMS“STEMI 警报”的时间、到达急诊部（ED）的时间以及 ED 医生实际激活导管实验室的时间，所有时间均使用同步时钟。主要结局指标是 STEMI 警报和实际激活之间的时间差（即潜在的节省时间）。还计算了假阳性率（护理人员错误诊断为 STEMI 的患者），并与当地接受的 10%假阳性率进行了比较。
在研究提前终止之前，共纳入了 12 名患者。平均和中位数潜在时间缩短分别为 15 分钟和 11 分钟（范围 7-29 分钟）。有一名假 STEMI 警报（假阳性率为 8.3%）是一位存在右束支传导阻滞的患者，随后被诊断为非 ST 段抬高型心肌梗死。当我们的心脏病专家根据我们的初始数据采用了院前导管实验室激活方案时，研究提前终止。
通过从现场激活 EMS 的导管实验室，似乎可以大大缩短再灌注时间，而在这个小样本中，假阳性率较低。这种类型的临床研究可以为多学科政策提供信息，并带来有意义的临床实践改变。
