Cardiac Outcomes Through Digital Evaluation (CODE) STEMI Project: Prehospital Digitally-Assisted Reperfusion Strategies
Cardiac Outcomes Through Digital Evaluation (CODE) STEMI Project: Prehospital Digitally-Assisted Reperfusion Strategies
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DOI：
10.1016/j.cjca.2012.02.005
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发表时间：
2012-07-01
影响因子：
6.2
通讯作者：
Tam, James W.
中科院分区：
文献类型：
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作者：
Ducas, Robin A.;Philipp, Roger K.;Tam, James W.
背景：加拿大心血管学会最近通过了 ST 段抬高型心肌梗死 (STEMI) 再灌注指南。我们开发了院前溶栓 (PHL) 治疗或初次经皮冠状动脉介入治疗 (PPCI) 激活的混合模型，以达到指导时间。方法：在我们拥有 658,700 人的城市中心，紧急医疗服务 (EMS) 接受了培训，可以执行和筛查疑似 STEMI 的心电图 (ECG)。可疑的心电图被传输到医生的手持设备上。如果医生确认诊断，他们会协调启动 PHL 或 PPCI。如果医生发现院前心电图 STEMI (PHENST) 呈阴性，患者就会被送往最近的急诊室。 结果：从 2008 年 7 月 21 日到 2010 年 7 月 21 日，数字评估心脏结果 (CODE) STEMI 项目收到了 380 个转接呼叫。值班医生确认了 226 例 STEMI，其中 158 例 (70%) 接受了 PPCI，48 例 (21%) 接受了 PHL，20 例 (9%) 进行了血管造影但没有进行血运重建。 PPCI，从第一次医疗接触到再灌注的中位时间为 76 分钟（四分位距 [IQR]，64-93）。对于 PHL，从首次医疗接触到针刺的中位时间为 32 分钟（IQR，29-39）。 STEMI 患者的总死亡率为 8%（PHL = 4 [8.3%]，PPCI = 8 [5%]，药物治疗 = 7 [35%]）。共有 154 名 PHENST 患者，其中 44% 后来被诊断为急性冠状动脉综合征。 PHENST 的死亡率为 14%。 结论：通过 EMS 院前心电图解释、数字传输、与医生直接沟通以及快速协调服务的模型，我们证明可以实现 STEMI 的基准再灌注时间。
Background: Guidelines for reperfusion in ST-elevation myocardial infarction (STEMI) were recently adopted by the Canadian Cardiovascular Society. We have developed a blended model of prehospital thrombolytic (PHL) therapy or primary percutaneous coronary intervention (PPCI) activation, in order to achieve guideline times.Methods: In our urban centre of 658,700 people, emergency medical services (EMS) were trained to perform and screen electrocardiograms (ECGs) for suspected STEMI. Suspected ECGs were transmitted to a physician's hand-held device. If the physician confirmed the diagnosis they coordinated initiation of either PHL or PPCI. In cases where physicians found the prehospital ECG negative for STEMI (PHENST), patients were transported to the closest emergency room.Results: From July 21, 2008 to July 21, 2010, the Cardiac Outcomes Through Digital Evaluation (CODE) STEMI project received 380 transmitted calls. There were 226 confirmed STEMI by the on-call physician, 158 (70%) received PPCI, 48 (21%) received PHL, and 20 (9%) had angiography but no revascularization. The PPCI, median time from first medical contact to reperfusion was 76 minutes (interquartile range [IQR], 64-93). For PHL, median time from first medical contact to needle was 32 minutes (IQR, 29-39). The overall mortality rate for the STEMI patients was 8% (PHL = 4 [8.3%], PPCI = 8 [5%], medical therapy = 7 [35%]). There were 154 PHENST patients, 44% later diagnosed with acute coronary syndrome. The mortality rate for PHENST was 14%.Conclusions: Through a model of EMS prehospital ECG interpretation, digital transmission, direct communication with a physician, and rapid coordinated service, we demonstrate that benchmark reperfusion times in STEMI can be achieved.