Optimizing prehospital ST-segment elevation myocardial infarction pathways, medical dispatch types and acute management times: A French regional registry study.
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引用次数: 0
Abstract
Background: Efficient management of emergency medical services is crucial, particularly during dispatch, to direct patients with ST-segment elevation myocardial infarction (STEMI) to the fastest medical intensive care unit pathway, bypassing emergency departments (EDs) at hospitals capable and incapable of percutaneous coronary intervention (PCI). A detailed analysis of emergency pathways may reveal key actions to improve patient care and outcomes.
Aim: To describe the initial STEMI pathways, with a focus on dispatch management, acute management times and revascularization strategies for each pathway: medical intensive care unit; ED at PCI-capable hospital; and ED at PCI-incapable hospital.
Methods: Multicentre retrospective study of all adult patients with STEMI diagnosed by emergency physicians within 24hours of symptom onset, and managed in any of the 19 medical intensive care units, seven PCI-capable hospitals and 25 PCI-incapable hospitals in the Aquitaine region from 1st January 2017 to 31st December 2021. The primary endpoint was the proportion of patients who missed the fastest pathway because of mistriage. The secondary endpoints focused on time intervals from symptom onset to balloon inflation.
Results: The study sample comprised 8344 patients: 57% (95% confidence interval [CI] 56-58%) followed the fastest pathway; and 21% (95% CI 20-22%) missed it because of mistriage. The median (interquartile range) time spent in the ED was 78 (48-150) minutes at PCI-capable hospitals and 109 (71-178) minutes at PCI-incapable hospitals. Only 11% (95% CI 10-12%) of patients managed in EDs at PCI-incapable hospitals received fibrinolysis, and 79% (95% CI 76-82%) exceeded the recommended 120minutes from first medical contact to balloon for the primary PCI strategy.
Conclusions: These findings should prompt French policymakers to improve the accuracy of dispatch and develop specific STEMI networks in EDs. Time lost in EDs or because of mistriage represents a considerable loss of opportunity for patients. The role of fibrinolysis should be reconsidered.
背景：有效的紧急医疗服务管理至关重要，特别是在调度过程中，将st段抬高型心肌梗死（STEMI）患者引导到最快的医学重症监护病房途径，绕过有能力和没有能力进行经皮冠状动脉介入治疗（PCI）的医院的急诊科（EDs）。对急救途径的详细分析可能揭示改善患者护理和结果的关键行动。目的：描述最初的STEMI途径，重点关注每个途径的调度管理、急性管理时间和血运重建策略：医疗重症监护室；pci医院的急诊科；和pci无能医院的急诊科方法：对2017年1月1日至2021年12月31日期间在阿基坦地区19家医疗重症监护病房、7家pci能力医院和25家pci能力医院中的任何一家就诊的急诊医生在症状出现24小时内诊断的所有STEMI成年患者进行多中心回顾性研究。主要终点是由于失败而错过最快途径的患者比例。次要终点集中在从症状出现到球囊膨胀的时间间隔。结果：研究样本包括8344例患者：57%（95%置信区间[CI] 56-58%）遵循最快途径；21%（95%可信区间20-22%）的患者因为失败而错过了手术。在pci能力强的医院，在急诊科花费的时间中位数（四分位数范围）为78（48-150）分钟，在pci能力弱的医院为109（71-178）分钟。只有11% （95% CI 10-12%）的患者在无PCI能力的医院急诊科接受了纤溶治疗，79% （95% CI 76-82%）的患者超过了最初PCI策略推荐的从首次医疗接触到球囊的120分钟。结论：这些发现应促使法国决策者提高调度的准确性，并在急诊科开发特定的STEMI网络。在急诊科浪费的时间或因失败而失去的机会对病人来说是相当大的损失。应重新考虑纤溶的作用。
期刊介绍：
The Journal publishes original peer-reviewed clinical and research articles, epidemiological studies, new methodological clinical approaches, review articles and editorials. Topics covered include coronary artery and valve diseases, interventional and pediatric cardiology, cardiovascular surgery, cardiomyopathy and heart failure, arrhythmias and stimulation, cardiovascular imaging, vascular medicine and hypertension, epidemiology and risk factors, and large multicenter studies. Archives of Cardiovascular Diseases also publishes abstracts of papers presented at the annual sessions of the Journées Européennes de la Société Française de Cardiologie and the guidelines edited by the French Society of Cardiology.
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