PMID- 19166637
OWN - NLM
STAT- MEDLINE
DCOM- 20090505
LR  - 20191027
IS  - 1481-8043 (Electronic)
IS  - 1481-8035 (Linking)
VI  - 11
IP  - 1
DP  - 2009 Jan
TI  - Impact of a rapid access protocol on decreasing door-to-balloon time in acute ST 
      elevation myocardial infarction.
PG  - 29-35
AB  - OBJECTIVE: Ischemic cardiovascular disease is the leading cause of death in 
      Canada. In ST elevation myocardial infarction (STEMI), time to reperfusion is a 
      key determinant in reducing morbidity and mortality with percutaneous coronary 
      intervention (PCI) being the preferred reperfusion strategy. Where PCI is 
      available, delays to definitive care include times to electrocardiogram (ECG) 
      diagnosis and cardiovascular laboratory access. In 2004, the Cardiac Care Network 
      of Ontario recommended implementation of an emergency department (ED) protocol to 
      reduce reperfusion time by transporting patients with STEMI directly to the 
      nearest catheterization laboratory. The model was implemented in Frontenac County 
      in April 2005. The objective of this study was to assess the effectiveness of a 
      protocol for rapid access to PCI in reducing door-to-balloon times in STEMI. 
      METHODS: Two 1-year periods before and after implementation of a rapid access to 
      PCI protocol (ending March 2005 and June 2006, respectively) were studied. 
      Administrative databases were used to identify all subjects with STEMI who were 
      transported by regional emergency medical services (EMS) and received emergent 
      PCI. The primary outcome measure was time from ED arrival to first balloon 
      inflation (door-to-balloon time). Times are presented as medians and 
      interquartile ranges (IQRs). Statistical comparisons were made using the 
      Mann-Whitney U test and presented graphically with Kaplan-Meier curves. RESULTS: 
      Patients transported under the rapid access protocol (n = 39) were compared with 
      historical controls (n = 42). Median door-to-balloon time was reduced from 87 
      minutes (IQR 67-108) preprotocol to 62 minutes (IQR 40-80) postprotocol (p < 
      0.001). CONCLUSION: In our region, implementation of an EMS protocol for rapid 
      access to PCI significantly reduced time to reperfusion for patients with STEMI.
FAU - Caudle, Jaelyn M
AU  - Caudle JM
AD  - Department of Emergency Medicine, Queen's University, Kingston, Ont. 
      jaelyncaudle@hotmail.com
FAU - Piggott, Zoe
AU  - Piggott Z
FAU - Dostaler, Suzanne
AU  - Dostaler S
FAU - Graham, Karen
AU  - Graham K
FAU - Brison, Robert J
AU  - Brison RJ
LA  - eng
PT  - Journal Article
PL  - England
TA  - CJEM
JT  - CJEM
JID - 100893237
SB  - IM
MH  - Adult
MH  - Aged
MH  - Aged, 80 and over
MH  - *Angioplasty, Balloon, Coronary
MH  - Electrocardiography
MH  - *Emergency Medical Services
MH  - Female
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Myocardial Infarction/physiopathology/*therapy
MH  - Time Factors
MH  - Transportation of Patients
MH  - Young Adult
EDAT- 2009/01/27 09:00
MHDA- 2009/05/06 09:00
CRDT- 2009/01/27 09:00
PHST- 2009/01/27 09:00 [entrez]
PHST- 2009/01/27 09:00 [pubmed]
PHST- 2009/05/06 09:00 [medline]
AID - 84cb5fd318d44d13b9ba4f7c52f94315 [pii]
AID - 10.1017/s1481803500010897 [doi]
PST - ppublish
SO  - CJEM. 2009 Jan;11(1):29-35. doi: 10.1017/s1481803500010897.