Should thrombolytic therapy be administered in the mobile intensive care unit in patients with evolving myocardial infarction? A pilot study.
The growing recognition of the importance of early thrombolysis in evolving myocardial infarction was the basis for the present study, which evaluated the effectiveness, feasibility and safety of prehospital thrombolytic therapy. In a relatively small study, 118 patients were allocated to receive either prehospital treatment with recombinant tissue-type plasminogen activator (rt-PA) in the mobile intensive care unit (group A, 74 patients) or hospital treatment (group B, 44 patients). A total of 120 mg of rt-PA was infused over a period of 6 h. All patients were fully heparinized and underwent radionuclide left ventriculography and coronary angiography during hospitalization. Although group A was treated significantly earlier than group B after onset of symptoms (94 +/- 36 versus 137 +/- 45 min, respectively; p less than 0.001), no significant differences were observed between the groups in 1) extent of myocardial necrosis, 2) global left ventricular ejection fraction at discharge, 3) patency of infarct-related artery, 4) length of hospital stay, and 5) mortality at 60 days. However, a trend to a lower incidence of congestive heart failure at hospital discharge was observed in the prehospital-treated compared with the hospital-treated group (7% versus 16%, respectively; p = NS). No major complications occurred during transportation. It is concluded that myocardial infarction can be accurately diagnosed and thrombolytic therapy initiated relatively safely during the prehospital phase by the mobile intensive care team, thus instituting a beneficial clinical trend in favor of prehospital thrombolysis.
Roth
A
A
Department of Cardiology, Tel-Aviv Medical Center, Israel.
Barbash
G I
GI
Hod
H
H
Miller
H I
HI
Rath
S
S
Modan
M
M
Har-Zahav
Y
Y
Keren
G
G
Bassan
S
S
Kaplinsky
E
E
D000368:Aged; D017023:Coronary Angiography; D003422:Critical Care; D004334:Drug Administration Schedule; D005260:Female; D005500:Follow-Up Studies; D006493:Heparin / Q000627:therapeutic use; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D008952:Mobile Health Units; D009203:Myocardial Infarction / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology / Q000503:physiopathology; D010865:Pilot Projects; D016032:Randomized Controlled Trials as Topic; D015996:Survival Rate; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage*; D014654:Vascular Patency / Q000187:drug effects
D006493:Heparin; D010959:Tissue Plasminogen Activator