EMS ACTIVATION OF THE CARDIAC CATHETERIZATION LABORATORY IS ASSOCIATED WITH PROCESS IMPROVEMENTS IN THE CARE OF MYOCARDIAL INFARCTION PATIENTS
EMS ACTIVATION OF THE CARDIAC CATHETERIZATION LABORATORY IS ASSOCIATED WITH PROCESS IMPROVEMENTS IN THE CARE OF MYOCARDIAL INFARCTION PATIENTS
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DOI：
10.3109/10903127.2013.773112
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发表时间：
2013-07-01
影响因子：
2.4
通讯作者：
Van Gelder, Carin
中科院分区：
文献类型：
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作者：
Cone, David C.;Lee, Christopher H.;Van Gelder, Carin
介绍。我们机构的先前数据表明，我们的护理人员可以通过院前 12 导联心电图 (ECG) 准确解读 ST 段抬高型心肌梗死 (STEMI)，并且护理人员在现场诊断 STEMI 后立即启动心导管实验室可能会减少门到球囊 (D2B) 时间。因此，“现场激活”方案于 2010 年 5 月启动。这项研究检查了前 14 个月内的 D2B 时间以及对国家 90 分钟 D2B 性能基准的遵守情况。假设。我们假设，与 EMS 未能激活导管插入实验室或 STEMI 患者通过 EMS 以外的方式到达时相比，当紧急医疗服务 (EMS) 激活导管插入实验室时，D2B 时间会更短，90 分钟依从性会更好。方法。在这项前瞻性、观察性研究中，对 2010 年 5 月至 2011 年 7 月间同一家医院连续发生 STEMI 患者的 EMS 和医院数据进行了审查。患者被分类为：1) EMS 现场激活，2) 由 EMS 转运但未激活 EMS 导管实验室激活的患者（例如，来自我们区域外的救护车、护理人员错过了 STEMI/违反协议），或 3) 前来就诊的 STEMI 患者。在 Excel 中处理数据，确定平均值、标准差 (SD) 和 95% 置信区间 (95% CI)，并使用 Dunnett 校正的方差分析 (ANOVA) 来比较组。结果。共有 38 名 EMS 现场激活、47 名未激活 EMS STEMI 到达以及 28 名预约 STEMI 患者。平均 (+/- SD) D2B 时间分别为 37 (+/- 17)、87 (+/- 40) 和 80 (+/- 23) 分钟。 EMS 场激活的 D2B 时间优于非激活 EMS 转运（平均值差异 35.3 分钟，95% CI 22.3-48.3 分钟，p < 0.001）或预约患者（平均值差异 37.0 分钟，95% CI 21.8-52.2 分钟，p < 0.001）。 90 分钟 D2B 基准的遵守率分别为 100%、72% 和 68%，并且 EMS 现场激活优于其他组 (p < 0.001)。结论。在所研究的系统中，对于 STEMI 患者的导管插入实验室的 EMS 现场激活与更短的 D2B 时间和更好地遵守 90 分钟基准相关，而不是对步入式 STEMI 患者或通过 EMS 到达但没有现场激活的 STEMI 患者进行 ED 激活。需要根据现场激活协议进行改进，以最大限度地发挥这些优势。
Introduction. Prior data from our institution suggested that our paramedics can accurately interpret ST-segment elevation myocardial infarction (STEMI) on prehospital 12-lead electrocardiograms (ECGs), and that activation of the cardiac catheterization laboratory by paramedics immediately upon diagnosing STEMI at the scene could potentially decrease door-to-balloon (D2B) times. A "field activation" protocol was thus initiated in May 2010. This study examined D2B times and compliance with the national 90-minute D2B performance benchmark in the first 14 months. Hypothesis. We hypothesized that D2B times would be shorter, and 90-minute compliance better, when the catheterization laboratory was activated by emergency medical services (EMS), compared with when either EMS failed to activate the catheterization laboratory or when the STEMI patient arrived by means other than EMS. Methods. For this prospective, observational study, EMS and hospital data were reviewed for consecutive STEMI patients at a single hospital between May 2010 and July 2011. Patients were cate-gorized as: 1) EMS field activations, 2) patients transported by EMS without EMS catheterization laboratory activation (e. g., ambulance from outside our area, paramedic missed STEMI/protocol violation), or 3) walk-in STEMI patient. Data were manipulated in Excel, means with standard deviations (SDs) and 95% confidence intervals (95% CIs) were determined, and analysis of variance (ANOVA) with Dunnett's correction was used to compare groups. Results. There were 38 EMS field activations, 47 nonactivation EMS STEMI arrivals, and 28 walk-in STEMI patients. The mean (+/- SD) D2B times were 37 (+/- 17), 87 (+/- 40), and 80 (+/- 23) minutes, respectively. D2B time was better for the EMS field activations than for either nonactivation EMS transports (difference of means 35.3 min, 95% CI 22.3-48.3 min, p < 0.001) or walk-in patients (difference of means 37.0 min, 95% CI 21.8-52.2 min, p < 0.001). Compliance with the 90-minute D2B benchmark was 100%, 72%, and 68%, respectively, and was better for the EMS field activations than for either of the other groups (p < 0.001). Conclusions. In the system studied, EMS field activation of the catheterization laboratory for patients with STEMI is associated with shorter D2B times and better compliance with 90-minute benchmarks than ED activation for either walk-in STEMI patients or STEMI patients arriving by EMS without field activation. Improvements are needed in compliance with the field activation protocol to maximize these benefits.