[Prehospital care of acute coronary syndrome by anaesthetists. Prospective comparison with the care standards of cardiologists].
BACKGROUND
Prehospital treatment of acute coronary syndrome (ACS) by anaesthetists acting in physician staffed emergency medical service (EMS) was compared with that of the gold standard of cardiologists.


METHODS
Prospectively 599 patients with assumed ACS were traced. Prehospital diagnosis and therapy were compared with re-evaluation of ECGs and diagnosis on hospital discharge.


RESULTS
In the case of ST-segment elevating myocardial infarction (STEMI) anaesthetists diagnosed 84% of cases correctly and cardiologists in 94% (p=0.048). False positive diagnoses were given in 11% by anaesthetists versus 5% by cardiologists (p=0.31). Anaesthetists accompanied all patients with instable angina versus 94% by cardiologists (p=0.06). Anaesthetists achieved 82% of patients to be pain-free versus 73% of cardiologists (p=0.01). Mortality until discharge was identical for the two groups (8.2%).


CONCLUSIONS
In prehospital management of ACS cardiologists showed higher diagnostic competence, whereas anaesthetists revealed a greater degree of therapeutic caution. Patient mortality was not influenced.
Breckwoldt
J
J
Klinik für Anästhesiologie und operative Intensivmedizin, Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12200 Berlin. jan.breckwoldt@charite.de
Müller
D
D
Overbeck
M
M
Stern
R
R
Schnitzer
L
L
Arntz
H R
HR
D054058:Acute Coronary Syndrome / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D000368:Aged; D000776:Anesthesiology / Q000592:standards*; D000789:Angina, Unstable / Q000175:diagnosis / Q000628:therapy; D000925:Anticoagulants / Q000008:administration & dosage / Q000627:therapeutic use; D002309:Cardiology / Q000592:standards*; D004562:Electrocardiography; D004632:Emergency Medical Services; D005189:False Positive Reactions; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology / Q000517:prevention & control; D011446:Prospective Studies; D015912:Thrombolytic Therapy; D014187:Transportation of Patients
D000925:Anticoagulants