PMID- 24329031
OWN - NLM
STAT- MEDLINE
DCOM- 20140605
LR  - 20220408
IS  - 1545-0066 (Electronic)
IS  - 1090-3127 (Linking)
VI  - 18
IP  - 1
DP  - 2014 Jan-Mar
TI  - Effect of prehospital cardiac catheterization lab activation on door-to-balloon 
      time, mortality, and false-positive activation.
PG  - 1-8
LID - 10.3109/10903127.2013.836263 [doi]
AB  - BACKGROUND: Reperfusion of ST elevation myocardial infarction (STEMI) is most 
      effective when performed early. Notification of the cardiac catheterization 
      laboratory (cath lab) prior to hospital arrival based on paramedic-performed ECGs 
      has been proposed as a strategy to decrease time to reperfusion and mortality. 
      The purpose of this study was to compare the effects of cath lab activation prior 
      to patient arrival versus activation after arrival at the emergency department 
      (ED). METHODS: We performed a retrospective cohort study (n = 1933 cases) using 
      Los Angeles County STEMI database from May 1, 2008 through August 31, 2009. The 
      database includes patients arriving at a STEMI Receiving Center (SRC) by 
      ambulance who were diagnosed with STEMI either before or after hospital arrival. 
      We compared the cohort of patients with prehospital cath lab activation to those 
      activated from the ED within 5 minutes of first ED ECG. Outcomes measured were 
      mortality, door-to-balloon time, percent door-to-balloon time <90 min, and 
      percentage of false-positive activations. RESULTS: Prehospital cath lab 
      activations had mean door-to-balloon times 14 minutes shorter (95% CI 11-17), 
      in-hospital mortality 1.5% higher (95% CI -1.0-5.2), and false-positive 
      activation 7.8%, (95% CI 2.7-13.3) higher than ED activation. For prehospital 
      activation, 93% (95% CI 91-94%) met a door-to-balloon target of 90 minutes versus 
      85% (95% CI 80-88%) for ED activations. CONCLUSION: Prehospital cath lab 
      activation based on the prehospital ECG was associated with decreased 
      door-to-balloon times but did not affect hospital mortality. False-positive 
      activation was common and occurred more often with prehospital STEMI diagnosis.
FAU - Squire, Benjamin T
AU  - Squire BT
FAU - Tamayo-Sarver, Joshua H
AU  - Tamayo-Sarver JH
FAU - Rashi, Paula
AU  - Rashi P
FAU - Koenig, William
AU  - Koenig W
FAU - Niemann, James T
AU  - Niemann JT
LA  - eng
PT  - Journal Article
PL  - England
TA  - Prehosp Emerg Care
JT  - Prehospital emergency care
JID - 9703530
SB  - IM
MH  - Angioplasty, Balloon, Coronary
MH  - Cardiac Catheterization
MH  - *Electrocardiography
MH  - Emergency Medical Services/*organization & administration
MH  - Emergency Service, Hospital/*organization & administration
MH  - False Positive Reactions
MH  - Humans
MH  - Los Angeles/epidemiology
MH  - Myocardial Infarction/*diagnosis/mortality/*therapy
MH  - Retrospective Studies
MH  - Time Factors
MH  - Treatment Outcome
EDAT- 2013/12/18 06:00
MHDA- 2014/06/06 06:00
CRDT- 2013/12/17 06:00
PHST- 2013/12/17 06:00 [entrez]
PHST- 2013/12/18 06:00 [pubmed]
PHST- 2014/06/06 06:00 [medline]
AID - 10.3109/10903127.2013.836263 [doi]
PST - ppublish
SO  - Prehosp Emerg Care. 2014 Jan-Mar;18(1):1-8. doi: 10.3109/10903127.2013.836263.