Safety and feasibility of prehospital thrombolysis carried out by paramedics

Keeling, Peter

doi:10.1136/bmj.327.7405.27

Cited by 44 publications

(27 citation statements)

References 2 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…A second study from the United Kingdom reached the same conclusion and reported a potential time savings of 48 minutes if the paramedics were to administer thrombolytic therapy in the field. 22 In the latter study the paramedics' sensitivity and specificity in identifying patients with STEMI was 71% and 97%, respectively, compared with 90% and 94% for doctors. Our findings are in keeping with these previous studies and further support the suggestion that a significant reduction in time to reperfusion could be achieved by paramedic administration of thrombolytic therapy.…”

Section: Discussionmentioning

confidence: 94%

“…20 Two studies evaluated the feasibility of paramedics interpreting the ECG and deciding autonomously on the administration of thrombolytic agents. 21,22 The first was a small pilot study performed in rural Wales, where paramedics were trained to recognize STEMI on the 12-lead ECG, independently determining the eligibility for thrombolysis before hospital arrival. 21 When compared with treatment subsequently received in hospital, there was a potential reduction in call-to-needle time of 41 minutes, and the study concluded that paramedic selection of patients for the pre-hospital administration of thrombolytic therapy was both feasible and safe.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Diagnostic performance and potential clinical impact of advanced care paramedic interpretation of ST-segment elevation myocardial infarction in the field

May

Dionne

Maloney

et al. 2006

CJEM

View full text Add to dashboard Cite

Objectives: Most studies of pre-hospital management of ST-elevation myocardial infarction (STEMI) have involved physicians accompanying the ambulance crew, or electrocardiogram (ECG) transmission to a physician at the base hospital. We sought to determine if Advanced Care Paramedics (ACPs) could accurately identify STEMI on the pre-hospital ECG and contribute to strategies that shorten time to reperfusion. Methods: A STEMI tool was developed to: 1) measure the accuracy of the ACPs at diagnosing STEMI; and 2) determine the potential time saved if ACPs were to independently administer thrombolytic therapy. Using registry data, we subsequently estimated the time saved by initiating thrombolytic therapy in the field compared with in-hospital administration by a physician. Results: Between August 2003 and July 2004, a correct diagnosis of STEMI on the pre-hospital ECG was confirmed in 63 patients. The performance of the ACPs in identifying STEMI on the ECG resulted in a sensitivity of 95% (95% confidence interval [CI] 86%-99%), a specificity of 96% (95% CI 94%-98%), a positive predictive value (PPV) of 82% (95% CI 71%-90%), and a negative predictive value (NPV) of 99% (95% CI 97%-100%). ACP performance for appropriately using thrombolytic therapy resulted in a sensitivity of 92% (95% CI 78%-98%), a specificity of 97% (95% CI 94%-98%), a PPV of 73% (95% CI 59%-85%) and an NPV of 99% (95% CI 97%-100%). We estimated that the median time saved by ACP administration of thrombolytic therapy would have been 44 minutes. Conclusions: ACPs can be trained to accurately interpret the pre-hospital ECG for the diagnosis of STEMI. These results are important for the design of regional integrated programs aimed at reducing delays to reperfusion. RÉSUMÉ Objectifs : La plupart des études sur la prise en charge préhospitalière des infarctus du myocarde avec élévation du segment S-T (IMEST) ont été faites dans un contexte où les médecins accompag- ORIGINAL RESEARCH • RECHERCHE ORIGINALE ADVANCES

show abstract

Section: Discussionmentioning

confidence: 94%

Section: Discussionmentioning

confidence: 99%

Diagnostic performance and potential clinical impact of advanced care paramedic interpretation of ST-segment elevation myocardial infarction in the field

May

Dionne

Maloney

et al. 2006

CJEM

View full text Add to dashboard Cite

show abstract

“…Several studies indicate that paramedics can successfully administer thrombolysis 16,17 with a low rate of inappropriate lysis. However, it does require additional training.…”

Section: Paramedic-initiated Thrombolysismentioning

confidence: 99%

Pros, Cons, and Organization of Prehospital Thrombolysis

Fletcher

Stewart

Savage

2013

Clinical Therapeutics

View full text Add to dashboard Cite

“…Safety is strongly dependent on a correct diagnosis and a variety of systems have been developed to either assist in the on scene interpretation of the ECG, or transmit it via a mobile telephone or radio for interpretation in hospital (31). Paramedic administered fibrinolysis is safe and effective (32,33).…”

Section: Secondary Assessment (Contraindications)mentioning

confidence: 99%