title: [Cardiological emergency network in Lombardy].
abstract: OBJECTIVE
  To achieve a reduction of time to reperfusion through the organization of an interhospital network and the involvement of the Regional Health Authority.
  
  
  METHODS
  Four major endpoints were identified: institutional governance action, clinical management of acute ST-elevation myocardial infarction (STEMI), priority actions for cardiac arrest and early defibrillation, actions to avoid the delay related to decision-making, and logistic factors. Since 2001 in the urban area of Milan a network has been operating among 23 coronary care units, the 118 Dispatch Center (national free number for medical emergencies) and the Health Country Government Agency named Group for Prehospital Cardiac Emergency. In order to monitor the network activity and time to treatment and clinical outcomes a periodic monthly survey, called MOMI (One Month Monitoring Myocardial Infarction), was undertaken and repeated twice yearly. Data were evaluated according to hospital admission modality.
  
  
  RESULTS
  Global times are: symptom onset to first medical contact 116 min (interquartile range [IQR] 189), time to first ECG 7 min (IQR 12), door-to-balloon time 77 min (IQR 81.7). Non-parametric test showed that the modality of hospital admittance was the most critical determinant of door-to-balloon time. The shortest one (49.5 min) was that of patients transported by means of advanced rescue units with 12-lead ECG teletransmission and activation of a fast track directly to the cath lab.
  
  
  CONCLUSIONS
  Our data show how in a complex urban area the organization of an interhospital network and the availability of ECG teletransmission are effective in reducing time to reperfusion, in the treatment of major arrhythmias and in pre-alert of coronary care units and cath labs in case of confirmed STEMI. This experience also stimulated an improvement in technological equipment of rescue units with extension of 12-lead teletransmission to basic life support units. Through the Health Country Government Agency and the Scientific Societies we carry on with our job to create a regional network for cardiac emergency involving all the hospitals.
authors.affiliation: U.O. di Cardiologia, A.O. San Carlo, Milano. Marzegalli.Maurizio@sancarlo.mi.it
authors.forename: Maurizio
authors.initials: M
authors.lastname: Marzegalli
authors.forename: Giancarlo
authors.initials: G
authors.lastname: Fontana
authors.forename: Giovanni
authors.initials: G
authors.lastname: Sesana
authors.forename: Niccolò
authors.initials: N
authors.lastname: Grieco
authors.forename: Federico
authors.initials: F
authors.lastname: Lombardi
authors.forename: Corrada
authors.initials: C
authors.lastname: Elena
authors.forename: Francesca
authors.initials: F
authors.lastname: Ieva
authors.forename: Anna Maria
authors.initials: AM
authors.lastname: Paganoni
mesh_terms: D001145:Arrhythmias, Cardiac / Q000628:therapy*; D002985:Clinical Protocols; D003325:Coronary Care Units / Q000458:organization & administration*; D004562:Electrocardiography / Q000295:instrumentation / Q000379:methods; D004630:Emergencies; D004632:Emergency Medical Services / Q000458:organization & administration*; D006801:Humans; D007558:Italy; D009203:Myocardial Infarction / Q000628:therapy*; D013686:Telemetry; D014187:Transportation of Patients / Q000458:organization & administration