Design of a standardized system for transfer of patients with ST-elevation myocardial infarction for percutaneous coronary intervention

Henry, Timothy D.; Unger, Barbara; Sharkey, Scott W.; Lips, Daniel; Pedersen, Wesley R.; Madison, James D.; Mooney, M.; Flygenring, Björn P.; Larson, David M.

doi:10.1016/j.ahj.2005.01.059

Cited by 129 publications

(93 citation statements)

References 16 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The system design and early results of the program have previously been published. 5,6 Thirty-one regional hospitals participate, including 11 hospitals within 60 miles of the PCI center (designated zone 1) and 20 hospitals between 60 and 210 miles away (zone 2). Standardized protocols and a predetermined transfer plan (ambulance or helicopter March 18, 2014 on the basis of locations and availability) are in place for each site.…”

Section: Methodsmentioning

confidence: 99%

ST-Elevation Myocardial Infarction Diagnosed After Hospital Admission

et al. 2014

Self Cite

View full text Add to dashboard Cite

show abstract

Section: Methodsmentioning

confidence: 99%

ST-Elevation Myocardial Infarction Diagnosed After Hospital Admission

et al. 2014

Self Cite

View full text Add to dashboard Cite

show abstract

“…In 2003, MHI-ANW implemented the Level 1 program, 18,19 a regional system that provides for the rapid transfer of patients with ST-segment elevation myocardial infarction (STEMI) for primary percutaneous coronary intervention (PCI) at ANW from across a network of 33 hospitals within a 210-mile radius of ANW. MHI provides training, education, protocols, and tool kits to participating hospitals, emergency medical services (EMS) agencies, and emergency transport providers.…”

Section: Setting and Program Developmentmentioning

confidence: 99%

Therapeutic Hypothermia After Out-of-Hospital Cardiac Arrest

et al. 2011

Self Cite

View full text Add to dashboard Cite

Background-Therapeutic hypothermia (TH) improves survival and confers neuroprotection in out-of-hospital cardiac arrest (OHCA), but TH is underutilized, and regional systems of care for OHCA that include TH are needed. Methods and Results-The Cool It protocol has established TH as the standard of care for OHCA across a regional network of hospitals transferring patients to a central TH-capable hospital. Between February 2006 and August 2009, 140 OHCA patients who remained unresponsive after return of spontaneous circulation were cooled and rewarmed with the use of an automated, noninvasive cooling device. Three quarters of the patients (nϭ107) were transferred to the TH-capable hospital from referring network hospitals. Positive neurological outcome was defined as Cerebral Performance Category 1 or 2 at discharge. Patients with non-ventricular fibrillation arrest or cardiogenic shock were included, and patients with concurrent ST-segment elevation myocardial infarction (nϭ68) received cardiac intervention and cooling simultaneously. Overall survival to hospital discharge was 56%, and 92% of survivors were discharged with a positive neurological outcome. Survival was similar in transferred and nontransferred patients. Non-ventricular fibrillation arrest and presence of cardiogenic shock were associated strongly with mortality, but survivors with these event characteristics had high rates of positive neurological recovery (100% and 89%, respectively). A 20% increase in the risk of death (95% confidence interval, 4% to 39%) was observed for every hour of delay to initiation of cooling. Conclusions-A comprehensive TH protocol can be integrated into a regional ST-segment elevation myocardial infarction network and achieves broad dispersion of this essential therapy for OHCA. (Circulation. 2011;124:206-214.)

show abstract

“…There also is interest in developing regional systems of care to improve the timeliness of reperfusion therapy and to increase access to primary PCI for STEMI patients who present to hospitals without PCI capability. [15][16][17] We implemented a protocol to optimize timeliness of reperfusion therapy and to coordinate systems of care for a PCI center and 28 regional hospitals located up to 150 miles away across 3 states. At the PCI center, our protocol implemented 4 of the 6 strategies determined by Bradley et al 14 and at the 28 regional hospitals, our protocol used novel strategies and systems of care to improve time to reperfusion.…”

Section: Editorial P 689 Clinical Perspective P 736mentioning

confidence: 99%

Regional Systems of Care to Optimize Timeliness of Reperfusion Therapy for ST-Elevation Myocardial Infarction

et al. 2007

View full text Add to dashboard Cite

Background-Quality improvement efforts have focused on strategies to improve the timeliness of reperfusion therapy in ST-elevation myocardial infarction patients who present to hospitals with and without percutaneous coronary intervention (PCI) capability. We implemented and evaluated a protocol to optimize the timeliness of reperfusion therapy and to coordinate systems of care for a PCI center and 28 regional hospitals located up to 150 miles away across 3 states. Methods and Results-The present study focused on a prospective, observational cohort of 597 patients who presented with ST-segment elevation and within 12 hours of symptom onset to Saint Marys Hospital and 28 regional hospitals up to 150 miles away between May 2004 and December 2006. The Mayo Clinic ST-elevation myocardial infarction protocol implemented strategies to improve timeliness of reperfusion therapy and to coordinate systems of care for transfer between hospitals. The study sample consisted of 258 patients who presented to Saint Marys Hospital and were treated with primary PCI (group A), 105 patients who presented to a regional hospital with symptom onset Ͼ3 hours and then were transferred for primary PCI (group B), and 131 patients who presented to a regional hospital with symptom onset Ͻ3 hours and were treated with full-dose fibrinolytic therapy (group C). For groups A and B, median door-to-balloon times were 71 and 116 minutes, respectively. Door-to-balloon time Ͻ90 minutes was achieved in 75% of group A and 12% of group B. Median door-to-needle time was 25 minutes for group C, and 70% had door-to-needle time Ͻ30 minutes. Conclusions-The Mayo Clinic ST-elevation myocardial infarction protocol demonstrates the feasibility of implementing strategies to optimize the timeliness of reperfusion therapy and the times that can be achieved through coordinated systems of care for ST-elevation myocardial infarction patients presenting to a PCI center (Saint Marys Hospital) and 28 regional hospitals without PCI capability located up to 150 miles away across 3 states. (Circulation. 2007;116:729-736.)

show abstract

Design of a standardized system for transfer of patients with ST-elevation myocardial infarction for percutaneous coronary intervention

Cited by 129 publications

References 16 publications

ST-Elevation Myocardial Infarction Diagnosed After Hospital Admission

ST-Elevation Myocardial Infarction Diagnosed After Hospital Admission

Therapeutic Hypothermia After Out-of-Hospital Cardiac Arrest

Regional Systems of Care to Optimize Timeliness of Reperfusion Therapy for ST-Elevation Myocardial Infarction

Contact Info

Product

Resources

About