Paramedic-led prehospital thrombolysis is safe and effective: the East Anglian experience.
BACKGROUND
Prehospital thrombolysis has been shown to improve patient outcomes in clinical trials and this has been confirmed in the ongoing large national myocardial infarction registry (Myocardial Infarction National Audit Project; MINAP) reports. This paper describes a system to improve the delivery of prehospital thrombolysis and the associated governance requirements to gain maximum patient benefit.


METHODS
Demographic data were prospectively collected on all patients treated by the East Anglian Ambulance Trust with bolus thrombolytics for a presumed diagnosis of ST elevation myocardial infarction between November 2003 and February 2007. Survival status was determined from the NHS strategic tracing service.


RESULTS
1062 patients (mean age 64.0 years (SD 10.6), 795 men) were treated in this time period. There were 71 deaths in this group, with actuarial survival of 93.9% (SE 0.9%) at 30 days, 91.7% (SE 1.0%) at 6 months and 90.8% (SE 1.1%) at 12 months after treatment. Age and cardiac arrest were most strongly associated with mortality (both p<0.001). Twelve (1.2%) patients received thrombolysis that on review was considered inappropriate. There were no deaths in this subgroup.


CONCLUSIONS
Prehospital thrombolysis can be administered safely by ambulance staff supported by a Trust clinical support system with excellent clinical outcomes.
Khan
S N
SN
Department of Cardiology, Papworth Hospital, Papworth Everard, Cambridge, UK.
Murray
P
P
McCormick
L
L
Sharples
L S
LS
Salahshouri
P
P
Scott
J
J
Schofield
P M
PM
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003695:Delivery of Health Care / Q000592:standards*; D004632:Emergency Medical Services / Q000592:standards*; D004634:Emergency Medical Technicians; D004739:England; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000188:drug therapy* / Q000401:mortality; D015912:Thrombolytic Therapy / Q000592:standards; D013997:Time Factors; D016896:Treatment Outcome
D005343:Fibrinolytic Agents