Clinical adverse events in prehospital patients with ST-elevation myocardial infarction transported to a percutaneous coronary intervention centre by basic life support paramedics in a rural region

Abstract

CLINICIAN'S CAPSULE What is known about the topic? ST-elevation myocardial infarction (STEMI) patients transported by ambulance are at risk for adverse events. What did this study ask? What is the impact of transport time on the occurrence of adverse events in the presence of basic life support paramedics? What did this study find? Transport time is not associated with a higher risk of adverse events. Why does this study matter to clinicians? Largest investigation of adverse events in a Canadian cohort of STEMI patients transported by ambulance.

Safety and clinically important events in PCP-initiated STEMI bypass in Ottawa

“…5,6 This is likely due to differing definitions of clinically important events. For example, minor events in the Bussières et al study would be classified as important in both our study and the study by Ryan et al 7 It is critical to note that clinically important events do not equal adverse events; rather they indicate acuity and potential need for intervention within this patient population. Similar to previous studies, we found that the most common events are hypotension and bradycardia.…”

“…Furthermore, our study is independently in agreement with two recent studies supporting the safety of PCP-only STEMI bypass, therefore adding to the mounting evidence of safety for PCP-only STEMI bypass. 7,8 Finally, we believe that our inclusion of an ACP-intercept cohort allows some determination of actual ACP intervention in the setting of encountered clinically important events.…”

“…5,6 Two recent studies have been published in this journal examining PCP STEMI bypass. 7,8 Bussières et al looked at a PCP STEMI bypass in a rural setting in a PCP-only EMS system, whereas Kwong et al evaluated a PCP STEMI bypass guideline in a dense urban environment with both PCP and ACP care. Our study adds to the existing literature examining the safety of a PCP STEMI bypass by examining its use in a different setting.…”

ST-segment elevation myocardial infarction (STEMI) bypass: The importance of paramedics in an integrated STEMI system of care

“…Bussieres et al present a rural environment with longer transport times ( > 30 minutes to the PCI centre). 4 Data on 1,114 patients over a period of 8 years reveal 18.5% major events and 12.2% minor for PCP STEMI bypass. Kwong et al recently presented data from an urban paramedic service.…”

“…5 In Mitchell and Bussieres, paramedics transmit and a remote physician is involved in making the decision. 3,4 Multiple studies document feasibility and accuracy of prehospital ECG by appropriately trained paramedics. 8 Studies support a time savings from the first diagnostic ECG to device with prehospital acquisition of ECG.…”