Paramedic-administered prehospital thrombolysis is safe and reduces time to treatment.
BACKGROUND
The Kapiti Coast region is remote from Wellington Hospital with an ambulance transport time of 1 hour. To reduce delays in the treatment of myocardial infarction (MI), a prehospital thrombolysis (PHT) programme was initiated in 2003.


METHODS
This study evaluated outcomes of the Kapiti PHT programme between 2003 and 2007. Paramedics attending patients with suspected MI-transmitted electrocardiograms to our Coronary Care Unit where a physician made the decision whether or not to thrombolyse. Thrombolysis was then administered by a paramedic. Patients from the Kapiti region treated with in-hospital thrombolysis (IHT) between 1999 and 2003 formed the control group.


RESULTS
A total of 50 Kapiti patients received PHT. The group receiving IHT were older than those receiving PHT but other baseline characteristics were similar. No patients without MI or with a contraindication received PHT. In the PHT group there was one minor bleed but no major bleeding, stroke or death occurred during transport to hospital. The median scene to thrombolytic time for PHT was 89 minutes faster (44 minutes versus 133, P<0.0001) than in patients transferred for IHT. The median scene to thrombolytic time for PHT was similar to the door to thrombolytic time for IHT (P=0.13). In-hospital mortality in the PHT group (8.0%) was similar to the IHT group (6.0%, P=1.0) but heart failure was reduced (10% vs. 26%, P=0.04)


CONCLUSIONS
Prehospital thrombolysis administered by paramedics is safe and reduces the time to treatment and was associated with a reduction in heart failure.
Ranchord
Anil M
AM
Department of Cardiology, Wellington Hospital, Wellington South, New Zealand.
Prasad
Sandhir
S
Matsis
Phillip
P
Harding
Scott A
SA
D000368:Aged; D000488:Allied Health Personnel; D004562:Electrocardiography; D004632:Emergency Medical Services / Q000379:methods*; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000188:drug therapy* / Q000401:mortality / Q000503:physiopathology; D009520:New Zealand / Q000453:epidemiology; D012189:Retrospective Studies; D015996:Survival Rate; D015912:Thrombolytic Therapy / Q000379:methods*; D013997:Time Factors; D016896:Treatment Outcome
D005343:Fibrinolytic Agents