Direct ambulance admission to the cardiac catheterization laboratory significantly reduces door-to-balloon times in primary percutaneous coronary intervention

Dorsch, Michael F.; Greenwood, John P; Priestley, Claire; Somers, Kathryn; Hague, Carole; Blaxill, Jonathan; Wheatcroft, Stephen; Mackintosh, Alan; McLenachan, James M.; Blackman, Daniel J.

doi:10.1016/j.ahj.2008.01.014

Cited by 72 publications

(52 citation statements)

References 21 publications

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“…Clinical assessment at a remote emergency department followed by inter-hospital transportation is time consuming and, as we have previously reported, may significantly increase door-to-balloon times. 17 Within our region, the maximum distance for interhospital transfer is approximately 22 miles, and so it likely that in geographically larger catchment areas the presence of DM may have a greater impact on door-balloon time.…”

Section: Discussionmentioning

confidence: 99%

“…16 Door-to-balloon time was defined as the interval from arrival at the first hospital door (district general hospital or tertiary interventional centre) to the time of first balloon inflation or first use of a thrombectomy device. 17 Symptom-to-balloon time was taken from the patient's first self-reported experience of symptoms suggestive of myocardial ischemia. Call and door times were abstracted from the ambulance transfer report.…”

Section: Methodsmentioning

confidence: 99%

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Association of diabetes with increased all-cause mortality following primary percutaneous coronary intervention for ST-segment elevation myocardial infarction in the contemporary era

Kahn

Cubbon

Mercer

et al. 2011

Diabetes and Vascular Disease Research

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Background:We investigated the association between diabetes mellitus (DM) and all-cause mortality in a large cohort of consecutive patients treated with primary percutaneous coronary intervention (PPCI) in the contemporary era. Methods:We conducted a retrospective analysis of a single-centre registry of patients undergoing PPCI for ST-segment elevation myocardial infarction (STEMI) at a large regional PCI centre between 2005 and 2009. All-cause mortality in relation to patient and procedural characteristics was compared between patients with and without DM. Results: Of 2586 patients undergoing PPCI, 310 (12%) had DM. Patients with DM had a higher prevalence of multi-vessel coronary disease (p<0.001) and prior myocardial infarction (p<0.001). Patients with DM were less commonly admitted directly to the interventional centre (p=0.002). Symptom-to-balloon (p<0.001) and door-to-balloon time (p=0.002) were longer in patients with DM. Final infarct-related-artery TIMI-flow grade was lower in patients with DM (p=0.031). All-cause mortality at 30 days (p=0.0025) and 1 year (p<0.0001) was higher in patients with DM. DM was independently associated with increased mortality after multivariate adjustment for potential confounders. Conclusions: Mortality remains substantially higher in patients with DM following reperfusion for STEMI in comparison with those without diabetes, despite contemporary management with PPCI. Greater co-morbidity, delayed presentation, longer times-to-reperfusion, and less optimal reperfusion may contribute to adverse outcomes.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Association of diabetes with increased all-cause mortality following primary percutaneous coronary intervention for ST-segment elevation myocardial infarction in the contemporary era

Kahn

Cubbon

Mercer

et al. 2011

Diabetes and Vascular Disease Research

View full text Add to dashboard Cite

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“…7 Other recommended strategies to meet reperfusion target times are expedited transfer of STEMI patients from hospitals without PCI capabilities to hospitals with PCI capabilities, and bypassing a non-PCI hospital for a PCI hospital when EMS personnel suspect STEMI. 1,7,[19][20][21][22][23][24] Finally, a number of clinical trials, including several from Canada, have demonstrated the feasibility and safety of prehospital administration of fibrinolytics to patients with STEMI, 11,[25][26][27][28][29][30][31][32] and this is recommended as an alternative strategy for EMS systems capable of fibrinolytic therapy to minimize total ischemic time. 8,19 The degree to which EMS operators have adopted recommended strategies to detect and facilitate treatment of STEMI patients is unclear, despite growing evidence that the strategies are effective in reducing reperfusion delays.…”

Section: Introductionmentioning

confidence: 99%

Underuse of prehospital strategies to reduce time to reperfusion for ST-elevation myocardial infarction patients in 5 Canadian provinces

Schull

Vaillancourt²,

Donovan³

et al. 2009

CJEM

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Objective: Timely reperfusion therapy for ST-elevation myocardial infarction (STEMI) is an important determinant of outcome, yet targets for time to treatment are frequently unmet in North America. Prehospital strategies can reduce time to reperfusion. We sought to determine the extent to which emergency medical services (EMS) use these strategies in Canada. Methods: We carried out a cross-sectional survey in 2007 of ground EMS operators in British Columbia, Alberta, Ontario, Quebec and Nova Scotia. We focused on the use of 4 prehospital strategies: 1) 12-lead electrocardiogram (ECG), 2) routine expedited emergency department (ED) transfer of STEMI patients (from a referring ED to a percutaneous coronary intervention [PCI] centre), 3) prehospital bypass (ambulance bypass of local EDs to transport patients directly to PCI centres) and 4) prehospital fibrinolysis. Results: Ninety-seven ambulance operators were surveyed, representing 15 681 paramedics serving 97% of the combined provincial populations. Of the operators surveyed, 68% (95% confidence interval [CI] 59%-77%) had ambulances equipped with 12-lead ECGs, ranging from 40% in Quebec to 100% in Alberta and Nova Scotia. Overall, 47% (95% CI 46%-48%) of paramedics were trained in ECG acquisition and 40% (95% CI 39%-41%) were trained in ECG interpretation. Only 18% (95% CI 10%-25%) of operators had prehospital bypass protocols; 45% (95% CI 35%-55%) had protocols for expedited ED transfer. Prehospital fibrinolysis was available only in Alberta. All EMS operators in British Columbia, Alberta and Nova Scotia used at least 1 of the 4 prehospital strategies, and one-third of operators in Ontario and Quebec used 0 of 4. In major urban centres, at least 1 of the 3 prehospital strategies 12-lead ECG acquisition, bypass or expedited transfer was used, but there was considerable variation within and across provinces. Conclusion:The implementation of widely recommended prehospital STEMI strategies varies substantially across the 5 provinces studied, and relatively simple existing technologies, such as prehospital ECGs, are underused in many regions. Substantial improvements in prehospital services and better integration with hospital-based care will be necessary in many regions of Canada if optimal times to reperfusion, and associated outcomes, are to be achieved.

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“…In fact, it has been shown that treatment delays, even within the hospital, are associated with increased mortality and morbidity (16). Although the identification of factors affecting treatment times and methods to eliminate or minimize these treatment delays remains a major area of AMI research, most investigations have only focused on ways to decrease the door- to-balloon time (17)(18)(19)(20). As a result, door-to-balloon times have decreased from 120 minutes to 90 minutes (12).…”

Section: Discussionmentioning

confidence: 99%

Impact of emergency services and ambulance type on pain-to-balloon time in the acute myocardial infarction: an observational study

Karabulut¹,

Cakmak²,

Uzunlar³

et al. 2012

Anadolu Kardiyol Derg

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Objective: The objective of this study was to evaluate the role of first contact emergency departments and ambulances on transport duration, pain-to-balloon time, door-to-balloon time and first contact-to-balloon time in acute myocardial infarction (AMI) patients. Methods: The study was a prospective and observational investigation. A total of 374 AMI patients initially admitted to primary coronary intervention (PCI) incapable centers were included in this study. Patients were classified according to initial presentation site (daily clinic, public hospital or private hospital) and transport manner (public or private ambulance). All groups were compared by the Kruskal-Wallis and MannWhitney U tests statistically according to their characteristics, transport duration and pain-to-balloon time.Results: A majority of the patients were initially admitted to public (40.1%) or private hospitals (47.1%). The average door-to-balloon time was 45.0±18.5 min and the mean pain-to-balloon time was 310.6±160.8 min. Nearly half of the patients initially admitted to daily clinics were first transported to PCI-incapable centers, leading to delayed admission to PCI-capable centers and increased pain-to-balloon and first contact-toballoon times (361.7±194.5 min, p=0.01 and 279.7±158.2 min, p<0.001). Patients admitted to private hospitals experienced shorter average painto-balloon and first contact-to-balloon times (277.5±148.6 min, p=0.01 and 157.4±83.1 min, p<0.001). Patients transported by private ambulances also experienced shorter waiting times and shorter pain-to-balloon times (107.4±70.4 and 270.1±150.4 min, p<0.001). Conclusion: Physicians and healthcare professionals in first contact emergency departments and ambulance type appear to be factors in the increased pain-to-balloon time. AMI patients are often initially admitted to PCI-incapable centers, leading to delayed admission to PCI-capable centers and increased pain-to-balloon time. (Anadolu Kardiyol Derg 2012; 12: 23-9) Key words: Emergency services, ambulance, pain-to-balloon time 23ÖZET Amaç: Bu çalışma ileriye dönük gözlemsel bir araştırma olup; akut miyokart enfarktüslü (AME) hastalarında, ilk başvurulan acil servis ile ambulans tipinin hasta nakil süresi, ağrı-balon zamanı, kapı-balon süresi ve ilk kontak-balon süresi üzerindeki etkilerini araştırmayı amaçladık. Yöntemler: İlk olarak primer koroner girişim (PKG) imkânı olmayan hastanelere başvuran toplam 374 AMI hastası çalışmaya dâhil edildi. Hastalar ilk başvurdukları merkezlere göre; günlük klinik-tıp merkezi, devlet hastanesi ve özel hastane grubu olarak sınıflandırıldı. Hastalar aynı zamanda nakil sırasında kullanılan ambulans tipine göre de 112 ambulansı veya özel ambulans olarak iki grupta sınıflandırıldı. Tüm gruplar Kruskal-Wallis ve Mann-Whitney U testleri ile istatistiksel olarak demografik özellikler, nakil süresi ve ağrı-balon zamanına göre karşılaştırıldı. Bulgular: Hastaların çoğunluğu ilk olarak devlet hastanesi veya özel hastaneye başvurmuştu (40.1% ve 47.1%). Ortalama kapı-balon süresi 45.0...

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Direct ambulance admission to the cardiac catheterization laboratory significantly reduces door-to-balloon times in primary percutaneous coronary intervention

Cited by 72 publications

References 21 publications

Association of diabetes with increased all-cause mortality following primary percutaneous coronary intervention for ST-segment elevation myocardial infarction in the contemporary era

Association of diabetes with increased all-cause mortality following primary percutaneous coronary intervention for ST-segment elevation myocardial infarction in the contemporary era

Underuse of prehospital strategies to reduce time to reperfusion for ST-elevation myocardial infarction patients in 5 Canadian provinces

Impact of emergency services and ambulance type on pain-to-balloon time in the acute myocardial infarction: an observational study

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