Emergency Physician Discretion to Activate the Cardiac Catheterization Team Decreases Door-to-Balloon Time for Acute ST-Elevation Myocardial Infarction

Kraft, P.; Newman, Stacey; Hanson, Danette; Anderson, William C.; Bastani, Aveh

doi:10.1016/j.annemergmed.2007.03.013

Cited by 39 publications

(22 citation statements)

References 22 publications

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“…662,663 Twelve studies demonstrated that emergency physician activation of the catheterization laboratory was associated with significant reductions in door-to-balloon time intervals (20 to 68 minutes) (LOE 2 664 -666 ; LOE 3 [667][668][669][670][671][672][673] ; LOE 5 663,674 ). Falsepositive activation rate in these studies ranged from 0% to 15%.…”

Section: Consensus On Science Emergency Physician or Prehospital Actimentioning

confidence: 99%

“…Falsepositive activation rate in these studies ranged from 0% to 15%. 674,[663][664][665][666][667][668][669][670][671][672][673] Prehospital Activation of the Catheterization Laboratory. Seven studies demonstrated the effectiveness of prehospital activation on reducing door-to-balloon time intervals (22 to 69 minutes) (LOE 2 656,675 ; LOE 3 676,677 ; LOE 4 660,678 ).…”

Section: Consensus On Science Emergency Physician or Prehospital Actimentioning

confidence: 99%

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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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Section: Consensus On Science Emergency Physician or Prehospital Actimentioning

confidence: 99%

Section: Consensus On Science Emergency Physician or Prehospital Actimentioning

confidence: 99%

Part 9: Acute Coronary Syndromes

Bossaert

O’Connor²,

Arntz³

et al. 2010

Circulation

103

View full text Add to dashboard Cite

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“…32 In a community hospital in United States, the implementation of a STEMI protocol activated by the EP also decreased the door-to-balloon time from 147 to 106 minutes, with the proportion of patients having a door-to-balloon time of less than 90 minutes increasing from 16% to 39%. 33 The audit program implemented in our hospital retained a serial activation model, whereby the emergency cardiac catheterization team was activated solely by the cardiologists rather than by the EPs, as reported in the literature. 32,33 The unsatisfactory performance in our hospital underlines the important role of EP activation in any program to improve the door-to-balloon time.…”

Section: Discussionmentioning

confidence: 99%

“…33 The audit program implemented in our hospital retained a serial activation model, whereby the emergency cardiac catheterization team was activated solely by the cardiologists rather than by the EPs, as reported in the literature. 32,33 The unsatisfactory performance in our hospital underlines the important role of EP activation in any program to improve the door-to-balloon time.…”

Section: Discussionmentioning

confidence: 99%

Impact of an Audit Program and Other Factors on Door‐to‐balloon Times in Acute ST‐elevation Myocardial Infarction Patients Destined for Primary Coronary Intervention

Lai

Fan

Liao

et al. 2009

Academic Emergency Medicine

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Objectives: This before-after study investigated the association between an audit program and door-toballoon times in patients with acute ST-elevation myocardial infarction (STEMI) and explored other factors associated with the door-to-balloon time.Methods: An audit program that collected time data for essential time intervals in acute STEMI was developed with data feedback to both the Department of Emergency Medicine and the Department of Cardiology. The door-to-balloon times for 76 consecutive acute STEMI patients were collected from February 16, 2007, through October 31, 2007, after the implementation of the audit program, as the intervention group. The control group was defined by 104 consecutive acute STEMI patients presenting from April 1, 2006, through February 15, 2007, before the audit was applied. A multivariate linear regression model was used for analysis of factors associated with the door-to-balloon time.Results: The geometric mean 95% CI of the door-to-balloon time decreased from 164.9 (150.3, 180.9) minutes to 141.9 (127.4, 158.2) minutes (p = 0.039) in the intervention phase. The median door-to-balloon time was 147.5 minutes in the control group and 136.0 minutes in the intervention group (p = 0.09). In the multivariate regression model, the audit program was associated with a shortening of the door-toballoon time by 35.5 minutes (160.4 minutes vs. 195.9 minutes, p = 0.004); female gender was associated with a mean delay of 58.4 minutes (208.9 minutes vs. 150.5 minutes; p = 0.001); posterolateral wall infarction was associated with a mean delay of 70.5 minutes compared to anterior wall infarction (215.4 minutes vs. 144.9 minutes; p = 0.037) and a mean delay of 69.5 minutes compared to inferior wall infarction (215.4 minutes vs. 145.9 minutes; p = 0.044). The use of a glycoprotein IIb ⁄ IIIa inhibitor was associated with a 46.1 minutes mean shortening of door-to-balloon time (155.7 minutes vs. 201.8 minutes; p < 0.001). Conclusions:The implementation of an audit program was associated with a significant reduction in door-to-balloon times among patients with acute STEMI. In addition, female patients, posterolateral wall infarction territory, and nonuse of glycoprotein IIb ⁄ IIIa inhibitor were associated with longer door-toballoon times.ACADEMIC EMERGENCY MEDICINE 2009; 16:333-342 ª

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“…[32][33][34] Mean ECG-to-CCL activation time during our study period (7.5 ± 8.8 minutes) exceeded the recommended goal of ≤5 minutes, with a total of 31 of 72 cases exceeding this goal. One case demonstrated an ECG-to-CCL activation time of 42 minutes.…”

Section: Discussionmentioning

confidence: 99%

Factors Contributing to Door-to-Balloon Times of ≤90 Minutes in 97% of Patients with ST-Elevation Myocardial Infarction: Our One-Year Experience with a Heart Alert Protocol

Levis

Mercer²,

Thanassi³

et al. 2010

permj

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Context: Prompt percutaneous coronary intervention (PCI) for patients with ST-segment elevation myocardial infarction (STEMI) can significantly reduce mortality and morbidity, although its effectiveness may be limited by delays in delivery. In March 2008, our hospital implemented a Heart Alert protocol to rapidly identify and treat patients with STEMI presenting to our Emergency Department (ED) with PCI, using strategies previously described to reduce door-to-balloon times. Before the Heart Alert protocol start date, patients with STEMI presenting to our ED were treated with thrombolysis.Objective: We evaluated data from patients with STEMI after one year of use of our Heart Alert protocol to determine protocol success on the basis of the percentage of patients for whom the recommended door-to-balloon times of ≤90 minutes were met. We examined factors involved in implementation of the protocol that contributed to these results.Design: We conducted a retrospective data and chart review for patients in the ED with STEMI who underwent PCI after a Heart Alert protocol activation between March 17, 2008, and March 17, 2009.Results: During the study period, our staff met the recommended door-to-balloon time of ≤90 minutes (mean door-to-balloon time, 57.3 ± 17.6 minutes) for 70 of 72 patients (97%) presenting to our ED with STEMI. Sixty-five of the 72 patients (90.3%) survived to hospital discharge.Conclusion: Initiation of a Heart Alert protocol at our hospital resulted in achievement of door-to-balloon times of ≤90 minutes for 97% of patients with STEMI. This achievement was obtained through careful preparation, training, and interdepartmental collaboration and occurred despite immediate conversion from a previous thrombolytic protocol.

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Emergency Physician Discretion to Activate the Cardiac Catheterization Team Decreases Door-to-Balloon Time for Acute ST-Elevation Myocardial Infarction

Cited by 39 publications

References 22 publications

Part 9: Acute Coronary Syndromes

Part 9: Acute Coronary Syndromes

Impact of an Audit Program and Other Factors on Door‐to‐balloon Times in Acute ST‐elevation Myocardial Infarction Patients Destined for Primary Coronary Intervention

Factors Contributing to Door-to-Balloon Times of ≤90 Minutes in 97% of Patients with ST-Elevation Myocardial Infarction: Our One-Year Experience with a Heart Alert Protocol

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