Department of Emergency Medicine, Carolinas Medical Center, 1000 Blythe Blvd, Charlotte, NC 28203, USA.
Circulation. 2012 Jan 17;125(2):308-13. doi: 10.1161/CIRCULATIONAHA.110.007039. Epub 2011 Dec 6.
For patients with an acute ST-segment elevation myocardial infarction, cardiac catheterization laboratory (CCL) activation by emergency medical technicians or emergency physicians has been shown to substantially reduce treatment times. One drawback to this approach involves overtriage, whereby CCL staffs are activated for patients who ultimately do not require emergent coronary angiography or for patients who undergo angiography but are not found to have coronary artery occlusion.
We examined CCL activation at 14 primary angioplasty hospitals to determine the course of management, including the rate of inappropriate activation. Among 3973 activations (29% by emergency medical technicians, 71% by emergency physicians) between December 2008 and December 2009, appropriate CCL activations occurred for 3377 patients (85%), with 2598 patients (76.9% of appropriate activations) receiving primary percutaneous coronary intervention. Reasons for inappropriate activations (596 patients; 15%) included ECG reinterpretations (427 patients; 72%) or the fact that the patient was not a CCL candidate (169 patients; 28%). The rate of cancellation because of reinterpretation of emergency medical technicians' ECG (6% of all activations) was more common than for cancellation because of reinterpretation of emergency physicians' ECG (4.6%).
This represents the first report of the rates of CCL cancellation for ST-segment elevation myocardial infarction system activation by emergency medical technicians and emergency physicians in a large group of hospitals organized within a statewide program. The high rate of coronary intervention and relatively low rate of inappropriate activation suggest that systematic CCL activation by emergency personnel on a broad scale is feasible and accurate, and these rates set a benchmark for ST-segment elevation myocardial infarction systems.
对于急性 ST 段抬高型心肌梗死患者，急救医疗技术员或急诊医师激活心脏导管实验室（CCL）已被证明可大大缩短治疗时间。这种方法的一个缺点是过度分诊，即 CCL 工作人员被激活用于最终不需要紧急冠状动脉造影的患者，或用于接受血管造影但未发现冠状动脉闭塞的患者。
我们检查了 14 家直接经皮冠状动脉介入治疗医院的 CCL 激活情况，以确定管理过程，包括不适当激活的发生率。在 2008 年 12 月至 2009 年 12 月期间，有 3973 次激活（29%由急救医疗技术员，71%由急诊医师），其中 3377 例（85%）患者进行了适当的 CCL 激活，2598 例患者（适当激活的 76.9%）接受了经皮冠状动脉介入治疗。不适当激活的原因（596 例；15%）包括心电图重新解读（427 例；72%）或患者不是 CCL 候选者（169 例；28%）。由于急救医疗技术员 ECG 重新解读而取消的比例（所有激活的 6%）高于由于急诊医师 ECG 重新解读而取消的比例（4.6%）。
这是首次在一个由全州范围内组织的大型医院组中报告急救医疗技术员和急诊医师为 ST 段抬高型心肌梗死系统激活而取消 CCL 的比率。较高的冠状动脉介入率和相对较低的不适当激活率表明，急救人员广泛地系统激活 CCL 是可行和准确的，这些比率为 ST 段抬高型心肌梗死系统设定了基准。
