Paramedic-initiated helivac to tertiary hospital for primary percutaneous coronary intervention: a strategy for improving treatment delivery times.

Paramedic-initiated helivac to tertiary hospital for primary percutaneous coronary intervention: a strategy for improving treatment delivery times. J Thorac Dis. 2019 May;11(5):1819-1830 Authors: Davis P, Howie GJ, Dicker B, Garrett NK Abstract Background: In regions of New Zealand without coronary catheterisation laboratory (CCL) facilities, patients presenting with ST-elevation myocardial infarction (STEMI) are often subjected to prolonged delays before receiving primary percutaneous coronary intervention (PPCI) if it is the chosen reperfusion strategy. Therefore, we aimed to trial a new process of paramedic-initiated helivac of STEMI patients from the field directly to the CCL. Methods: Utilising a prospective observational approach, over a 48-month period, paramedics identified patients with a clinical presentation and electrocardiogram features consistent with STEMI and transported them directly to the regional air ambulance base for helivac to the CCL (flight time 30-35 minutes). These patients were compared to two historic STEMI cohorts either transported by paramedics to the region's local hospital or self-presenting, prior to helivac. The primary outcome measures were: first medical contact-to-balloon (FMCTB) time and accuracy of paramedic diagnosis. Secondary outcome measures were mortality at 30 days and six months, and hospital length of stay (LOS). Results: A total of 92 patients underwent helivac for PPCI (mean age of 64 years, SD &p...
Source: Journal of Thoracic Disease - Category: Respiratory Medicine Tags: J Thorac Dis Source Type: research

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Q-wave myocardial infarction (QWMI) comprises two entities. Firstly, a clinically evident MI, which can occur spontaneously or be related to a coronary procedure. Secondly, silent MI which is incidentally detected on serial electrocardiographic (ECG) assessment. The prevalence of silent MI after percutaneous coronary intervention (PCI) in the drug-eluting stent era has not been fully investigated. The GLOBAL LEADERS is an all-comers multicenter trial which randomized 15,991 patients undergoing PCI to two antiplatelet treatment strategies.
Source: The American Journal of Cardiology - Category: Cardiology Authors: Source Type: research
Abstract Objectives: Incomplete ST-segment elevation resolution (STR) occasionally occurs despite successful revascularization of epicardial coronary artery after primary percutaneous coronary intervention (PPCI). The aim of this study was to evaluate the relationship between the degree of STR and the severity of microvascular dysfunction. Methods: A total of 73 consecutive patients with ST-segment elevation myocardial infarction (STEMI) who underwent successful PPCI were evaluated. Serial 12-lead electrocardiography was performed at baseline and at 90 minutes after PPCI. Microvascular dysfunction was ...
Source: Cardiology Research and Practice - Category: Cardiology Authors: Tags: Cardiol Res Pract Source Type: research
Authors: Liu Y, Ding LY, Li XZ Abstract OBJECTIVE: To investigate the protective effect of ticagrelor on the myocardium of patients with ST-elevated acute coronary syndrome accompanied by diabetes mellitus. PATIENTS AND METHODS: 210 patients with diabetes mellitus receiving emergency percutaneous coronary intervention (PCI) due to ST-elevated acute coronary syndrome from December 2014 to June 2018 in the Hospital were selected and randomly divided into ticagrelor group and clopidogrel group. The myocardial microcirculation perfusion was evaluated via ST-segment elevation resolution (STR) in electrocardiogram (E...
Source: European Review for Medical and Pharmacological Sciences - Category: Drugs & Pharmacology Tags: Eur Rev Med Pharmacol Sci Source Type: research
Post by Smith and MeyersSam Ghali (https://twitter.com/EM_RESUS) just asked me (Smith):" Steve, do left main coronary artery *occlusions* (actual ones with transmural ischemia) have ST Depression or ST Elevation in aVR? "Smith and Meyers answer:First, LM occlusion is uncommon in the ED because most of these die before they can get a 12-lead recorded.But if they do present:The very common presentation of diffuse STD with reciprocal STE in aVR is NOT left main occlusion, though it might be due to subtotal LM ACS, but is much more often due to non-ACS conditions, especially demand ischemia. ...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs
This study described real-world clinical practice in prehospital management of STEMI patients in Queensland, Australia. Methods. Retrospective analysis of data sourced from the STEMI database of the Queensland Ambulance Service, Australia. Adult STEMI patients identified by paramedics between February 2008 and December 2018 in Queensland were included. Key aspects of prehospital STEMI care were described. Clinically-important time intervals from symptom onset to reperfusion were reported. Results. A total of 8,388 patients were included. The proportion of patients receiving prehospital reperfusion treatment has improved ma...
Source: Prehospital Emergency Care - Category: Endocrinology Tags: Prehosp Emerg Care Source Type: research
Early initiation of reperfusion therapy remains the cornerstone of successful management for ST-elevation myocardial infarction (STEMI). Rapid restoration of coronary blood flow relies on prompt recognition of the typical ST-segment elevation on a 12-lead electrocardiogram (ECG), - a surrogate for coronary occlusion or critical stenosis - allowing timely activation of the STEMI protocol cascade, with a major positive impact in mortality and clinical outcomes. However, atypical, very high risk ECG patterns - known as “STEMI equivalents” - are present in 10-25% of patients with ongoing myocardial ischemia in need...
Source: The American Journal of Cardiology - Category: Cardiology Authors: Source Type: research
CONCLUSIONS: These findings suggest that both physician-led and paramedic-led ambulances meet the criteria set out by the Polish and European authorities. All EMS time intervals are similar regardless of the type of EMS unit dispatched. A Physician being present on board did not have a prognostic impact on outcomes. PMID: 31313273 [PubMed - as supplied by publisher]
Source: Cardiology Journal - Category: Cardiology Authors: Tags: Cardiol J Source Type: research
Ischemia/reperfusion (I/R) injury is associated with primary percutaneous coronary intervention (PPCI). The current study was performed to compare the effect of tirofiban and recombinant human pro-urokinase (rh-proUK) on the improvement of coronary slow blood after PPCI. Sixty-five ST elevation myocardial infarction (STEMI) patients treated with rh-proUK and an equal number treated with tirofiban after PPCI were employed in the current study. The clinicopathological information regarding the biochemical parameters, thrombolysis in myocardial infarction (TIMI) grade, hemodynamics parameters, thrombus core (TS), sum-STR, le...
Source: Medicine - Category: Internal Medicine Tags: Research Article: Observational Study Source Type: research
Abstract ST-elevation myocardial infarction (STEMI) is a clinical diagnosis based on a compatible history and characteristic electrocardiographic changes. In the current era, STEMI is treated emergently with angiography, leading to percutaneous coronary intervention. However, false-positive electrocardiograms (ECGs) occur, resulting in unnecessary emergent catheterizations. We hypothesized that the Vectraplex cardiac electrical biomarker (CEB) would increase the specificity for the diagnosis of STEMI. We studied 50 patients who were identified by standard of care (clinical history, physical exam, and 12-lead ECG) ...
Source: Baylor University Medical Center Proceedings - Category: Universities & Medical Training Authors: Tags: Proc (Bayl Univ Med Cent) Source Type: research
Publication date: Available online 10 June 2019Source: Journal of Cardiology CasesAuthor(s): Hirokazu Shimono, Takashi Kajiya, Kosuke Saku, Masahiro Ueno, Junichiro Takaoka, Yoshihiko Atsuchi, Nobuhiko Atsuchi, Mitsuru OhishiAbstractA 75-year-old man with a history of hypertension was transferred to our hospital due to pulseless ventricular tachycardia. When return of spontaneous circulation was achieved, an electrocardiogram showed ST elevation in V1-4 leads. Successuful primary percutaneous coronary intervention was performed. However, on the next day, the patient’s systolic blood pressure dropped to 60 mmHg d...
Source: Journal of Cardiology Cases - Category: Cardiology Source Type: research
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