Department of Cardiology, Portsmouth Hospitals University NHS Trust, Portsmouth, UK.
Department of Cardiology, Altnagelvin Hospitals Health and Social Services Trust, Londonderry, UK.
BMJ Open. 2022 Feb 24;12(2):e046231. doi: 10.1136/bmjopen-2020-046231.
Evidence supports improved outcomes and reduced mortality with rapid reperfusion through primary percutaneous coronary intervention (PPCI) for ST-elevation myocardial infarction (STEMI). UK national audit data (Myocardial Ischaemia National Audit Project [MINAP]) demonstrates minor improvements in door-to-balloon times (DTB) of <90 min but increasing call-to-balloon times (CTB). We evaluate the effect of a regional Cardiologist delivered paramedic education programme (PEP) on DTB times and appropriate use of the PPCI pathway.
This was a prospective single-centre study of patients with STEMI brought directly to hospital via ambulance services. Data sources included ambulance charts, in-patient notes, British Cardiovascular Interventional Society (BCIS) database and local MINAP data. All DTB breaches were investigated. A local PEP was implemented with focus on ECG interpretation, STEMI diagnosis and appropriate use of the PPCI pathway. Non-parametric Wilcoxon rank test was used for comparisons of DTB and CTB times between direct versus ED-associated cath lab transfer.
A total of 728 patients with STEMI were admitted directly to our centre via ambulance, 66% (n=484) directly to the Catheterisation Laboratory (Cath Lab) and 34% (n=244) via the Emergency Department (ED). There was a significant increase in median DTB, 83 vs 37 min (p<0.001) and median CTB 144 vs 97.5 min (p<0.001) when transfer to the Cath Lab occurred via the ED versus direct transfer. The PEP increased direct cath lab transfers (52%-85%) and generated annual reductions in median DTB times, with sustained improvement seen throughout the 7-year study period.
Paramedic education increases direct transfer of STEMI patients to the Cath Lab, and reduces DTB times. This is an effective and reproducible intervention to facilitate timely reperfusion in STEMI.
通过直接经皮冠状动脉介入治疗（PPCI）治疗 ST 段抬高型心肌梗死（STEMI），可以迅速再灌注，改善预后，降低死亡率。英国国家审计数据（心肌缺血国家审计项目 [MINAP]）显示，门球时间（DTB）<90 分钟的改善较小，但呼叫球囊时间（CTB）在增加。我们评估区域心脏病专家提供的护理人员教育计划（PEP）对 DTB 时间和 PPCI 途径的合理应用的影响。
这是一项直接通过救护车服务送往医院的 STEMI 患者的前瞻性单中心研究。数据来源包括救护车图表、住院记录、英国心血管介入学会（BCIS）数据库和当地 MINAP 数据。所有 DTB 违规行为均进行了调查。实施了一项本地 PEP，重点是心电图解释、STEMI 诊断和 PPCI 途径的合理应用。直接与 ED 相关的导管实验室转移之间的 DTB 和 CTB 时间比较采用非参数 Wilcoxon 秩检验。
共有 728 例 STEMI 患者通过救护车直接送往我们中心，66%（n=484）直接送往导管室（Cath Lab），34%（n=244）通过急诊部（ED）。通过 ED 转至 Cath Lab 时，中位数 DTB 从 83 分钟增加到 37 分钟（p<0.001），中位数 CTB 从 144 分钟增加到 97.5 分钟（p<0.001）。PEP 增加了直接送往 Cath Lab 的转院患者（52%-85%），并使中位数 DTB 时间逐年减少，在整个 7 年的研究期间，持续改善。
护理人员教育增加了 STEMI 患者直接送往 Cath Lab 的转院，并缩短了 DTB 时间。这是一种有效的、可复制的干预措施，可以促进 STEMI 的及时再灌注。
