Prehospital Use of Aspirin Rarely Is Associated with Adverse Events

Quan, Dan; LoVecchio, Frank; Clark, Bryan; Gallagher, John V.

doi:10.1017/s1049023x00001990

Cited by 38 publications

(23 citation statements)

References 17 publications

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“…Other possible reasons for lower prevalence of aspirin administration could include absolute contraindications to aspirin such as a history of an anaphylactic response to aspirin or relative contraindications such as gastrointestinal bleed or kidney disease. However, prehospital use of aspirin is safe and rarely associated with adverse events 16. True aspirin intolerance or ‘allergy’ is estimated at only 2% to 3% of the general population 17.…”

Section: Discussionmentioning

confidence: 99%

Prehospital aspirin administration for acute coronary syndrome (ACS) in the USA: an EMS quality assessment using the NEMSIS 2011 database

2015

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Section: Discussionmentioning

confidence: 99%

Prehospital aspirin administration for acute coronary syndrome (ACS) in the USA: an EMS quality assessment using the NEMSIS 2011 database

2015

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“…283 Two other studies showed that the potential benefit from early aspirin administration outweighs potential harm (LOE 1). 284,285 Treatment Recommendations Despite limited direct evidence to support or refute the practice, it may be reasonable to consider EMS or dispatcherguided bystander aspirin administration, provided an adequate history to exclude a true allergy or a bleeding disorder, can be obtained. 293 was neutral in demonstrating benefit in the combined event rate of cardiovascular mortality, nonfatal infarction, nonfatal stroke, and overall mortality.…”

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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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“…Aspirin is recommended in the CPGs as it is safe, inexpensive, easy to administer and has significant benefits in reducing mortality and other vascular complications following myocardial infarction 7 8. A multicentre study of 922 patients with acute myocardial infarction showed that patients who received aspirin before arrival at hospital had a significantly lower mortality rate than those given aspirin following admission, both at 7 days (2.4% vs 7.3%, respectively) and at 30 days (4.9% vs 11.1%, respectively), as well as a lower incidence of serious complications including pulmonary oedema, cardiogenic shock and cardiac arrest 9…”

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confidence: 99%

Investigation of paramedics' compliance with clinical practice guidelines for the management of chest pain

Figgis¹,

Slevin

Cunningham

2010

Emergency Medicine Journal

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Prehospital treatment with oxygen, aspirin, sublingual GTN and ECG monitoring remains underused by paramedics, even though only a small number of patients had documented contraindications to their use. The small number of patients who received a prehospital 12-lead ECG is a cause of particular concern and suggests that incomplete patient assessment may contribute to undertreatment. Further provision of training and equipment is necessary to enable paramedics to more accurately assess and treat patients with acute coronary syndromes.

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Prehospital Use of Aspirin Rarely Is Associated with Adverse Events

Cited by 38 publications

References 17 publications

Prehospital aspirin administration for acute coronary syndrome (ACS) in the USA: an EMS quality assessment using the NEMSIS 2011 database

Prehospital aspirin administration for acute coronary syndrome (ACS) in the USA: an EMS quality assessment using the NEMSIS 2011 database

Part 9: Acute Coronary Syndromes

Investigation of paramedics' compliance with clinical practice guidelines for the management of chest pain

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