Early intravenous thrombolysis in acute myocardial infarction: the Jerusalem experience

Rozenman, Yoseph; Gotsman, Mervyn S.; Weiss, Avraham; Lotan, Chaim; Mosseri, Morris; Sapoznikov, Dan; Welber, Sima; Hasin, Yonathan; Gilon, Dan

doi:10.1016/0167-5273(95)02335-t

Cited by 23 publications

(6 citation statements)

References 42 publications

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“…The fact that GPs are the first point of contact suggests that initiation of treatment in this prehospital ‘window’ may be beneficial. GP/paramedic‐led prehospital thrombolysis has been used with much success elsewhere (The European Myocardial Infarction Project Group 1993, Rawles 1994, Rozenam et al. 1995) and its potential, which requires retraining of GPs, warrants further investigation.…”

Section: Discussionmentioning

confidence: 99%

Prehospital care pathway delays: gender and myocardial infarction

O’Donnell¹,

Condell²,

Begley³

et al. 2006

Journal of Advanced Nursing

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Section: Discussionmentioning

confidence: 99%

Prehospital care pathway delays: gender and myocardial infarction

O’Donnell¹,

Condell²,

Begley³

et al. 2006

Journal of Advanced Nursing

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“…Eleven studies showed that a greater proportion of the patients treated with prehospital fibrinolysis had shorter duration and increased frequency of total resolution of chest pain by the time of admission, ECG resolution, and decreased mortality (LOE 1 496,499,500,514 -516 ; LOE 2 505,506,508,511,513 ).…”

Section: Consensus On Sciencementioning

confidence: 99%

Part 9: Acute Coronary Syndromes

Bossaert

O’Connor²,

Arntz³

et al. 2010

Circulation

103

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These experts reviewed 25 topics related to the acute initial management of acute coronary syndrome (ACS), which was further categorized as unstable angina, non-ST-elevation MI (UA/NSTEMI) and ST-elevation MI (STEMI). Topics were identified based on previous recommendations, emerging science, and clinical importance, using an iterative writing process involving all Task Force members. The Task Force reviewed the evidence specifically related to diagnosis and treatment of ACS in the out-ofhospital setting and the first hours of care in the in-hospital setting, typically in the emergency department (ED). The evidence review took place over several years, with ongoing refinement of recommendations being made as new evidence was published. The purpose of the review was to generate current, evidence-based treatment recommendations for healthcare providers who serve as the initial point of contact for patients with signs and symptoms suggestive of ACS.The following is a summary of the most important changes in recommendations for diagnosis and treatment of ACS since the last ILCOR review in 2005. 1,2• The history and physical examination, initial ECG, and initial serum biomarkers, even when used in combination, cannot be used to reliably exclude ACS in the prehospital and ED settings.• In contrast, chest pain observation protocols are useful in identifying patients with suspected ACS and patients who require admission or may be referred for provocative testing for coronary artery disease (CAD) to identify reversible ischemia. Such strategies also reduce cost by reducing unnecessary hospital admissions and improve patient safety through more accurate identification of NSTEMI and STEMI.• The acquisition of a prehospital 12-lead ECG is essential for identification of STEMI patients before hospital arrival and should be used in conjunction with pre-arrival hospital notification and concurrent activation of the catheter laboratory.• Nonphysicians can be trained to independently interpret 12-lead ECGs for the purpose of identifying patients with STEMI, provided that appropriate and reliable STEMI criteria are used. This skill is of particular value in the prehospital setting where paramedics may independently identify STEMI, thus mitigating over-reliance on ECG transmission.• Computer-assisted ECG interpretation can be used to increase diagnostic accuracy of STEMI diagnosis when used alone or in combination with ECG interpretation by a trained healthcare provider.• STEMI systems of care can be implemented to improve the time to treatment. The following measures have been shown to reduce the time to primary percutaneous coronary intervention (PPCI): institutional commitment, use of a team-based approach, arranging single-call activation of the catheterization laboratory by the emergency physician or prehospital provider, requiring the catheterization laboratory to be ready in 20 minutes, having an experienced cardiologist always available, and providing real-time data feedback.• Intravenous (IV) ␤-blockers should not be give...

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“…The prehospital administration reduced time to thrombolysis and duration of pain but failed to reduce hospital mortality. Ventricular function was better in the prehospital group 55 …”

Section: Prehospital Thrombolysismentioning

confidence: 87%

“…Ventricular function was better in the prehospital group. 55 Each study shows an improvement in mortality although many do not reach significance, which is only achieved by meta-analysis. All studies with thrombolysis times quoted showed improvement.…”

Section: Prehospital Thrombolysismentioning

confidence: 99%

The case for prehospital thrombolysis in acute myocardial infarction

Cooke

2000

Emergency Medicine

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Thrombolysis is of proven benefit in improving survival after acute myocardial infarction. The benefit decreases with time after the onset of pain; the first 2 h appear to be important. Reduction of thrombolysis times must be undertaken as a whole‐systems approach. Delays in the patient contacting assistance services are unavoidable, but once contact is made the system should ensure attendance of a qualified person within 8 min. In‐hospital delays should be decreased, aiming for a door‐to‐needle time of less than 30 min. Prehospital electrocardiographs are accurate and can help reduce in‐hospital delays. Some trials have shown that prehospital administration of thrombolysis can lead to reduced thrombolysis times. Angioplasty with or without stenting for those with contraindications to thrombolysis and as a rescue procedure needs to be considered in deciding the destination of AMI patients. More evidence is needed to support this aspect of care. Prehospital thrombolysis has an important role to play, especially when time to hospital may be prolonged.

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Early intravenous thrombolysis in acute myocardial infarction: the Jerusalem experience

Cited by 23 publications

References 42 publications

Prehospital care pathway delays: gender and myocardial infarction

Prehospital care pathway delays: gender and myocardial infarction

Part 9: Acute Coronary Syndromes

The case for prehospital thrombolysis in acute myocardial infarction

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