title: The pre-hospital fibrinolysis experience in Europe and North America and implications for wider dissemination.
abstract: OBJECTIVE
  The primary objective of this report was to describe the infrastructures and processes of selected European and North American pre-hospital fibrinolysis (PHL) programs. A secondary objective is to report the outcome data of the PHL programs surveyed.
  
  
  BACKGROUND
  Despite its benefit in reducing mortality in patients with ST-segment elevation myocardial infarction, PHL remained underused in North America. Examination of existing programs may provide insights to help address barriers to the implementation of PHL.
  
  
  METHODS
  The leading investigators of PHL research projects/national registries were invited to respond to a survey on the organization and outcomes of their affiliated PHL programs.
  
  
  RESULTS
  PHL was successfully deployed in a wide range of geographic territories (Europe: France, Sweden, Vienna, England, and Wales; North America: Houston, Edmonton, and Nova Scotia) and was delivered by healthcare professionals of varying expertise. In-hospital major adverse outcomes were rare with mortality of 3% to 6%, reinfarction of 2% to 5%, and stroke of <2%.
  
  
  CONCLUSIONS
  Combining formal protocols for PHL for some patients with direct transportation of others to a percutaneous coronary intervention hospital for primary percutaneous coronary intervention would allow for tailored reperfusion therapy for patients with ST-segment elevation myocardial infarction. Insights from a variety of international settings may promote widespread use of PHL and increase timely coronary reperfusion worldwide.
authors.affiliation: Division of Cardiology, Department of Medicine, McGill Health University Center, Montreal, Quebec, Canada. thao.huynhthanh@mail.mcgill.ca
authors.forename: Thao
authors.initials: T
authors.lastname: Huynh
authors.forename: John
authors.initials: J
authors.lastname: Birkhead
authors.forename: Kurt
authors.initials: K
authors.lastname: Huber
authors.forename: Jennifer
authors.initials: J
authors.lastname: O'Loughlin
authors.forename: Ulf
authors.initials: U
authors.lastname: Stenestrand
authors.forename: Clive
authors.initials: C
authors.lastname: Weston
authors.forename: Tomas
authors.initials: T
authors.lastname: Jernberg
authors.forename: Michael
authors.initials: M
authors.lastname: Schull
authors.forename: Robert C
authors.initials: RC
authors.lastname: Welsh
authors.forename: Ali E
authors.initials: AE
authors.lastname: Denktas
authors.forename: Andrew
authors.initials: A
authors.lastname: Travers
authors.forename: Sunil
authors.initials: S
authors.lastname: Sookram
authors.forename: Pierre
authors.initials: P
authors.lastname: Theroux
authors.forename: Jack V
authors.initials: JV
authors.lastname: Tu
authors.forename: Adams
authors.initials: A
authors.lastname: Timmis
authors.forename: Richard
authors.initials: R
authors.lastname: Smalling
authors.forename: Nicolas
authors.initials: N
authors.lastname: Danchin
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D002985:Clinical Protocols; D019033:Delivery of Health Care, Integrated; D004632:Emergency Medical Services; D005060:Europe; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage* / Q000009:adverse effects; D019538:Health Care Surveys; D006297:Health Services Accessibility; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality; D009656:North America; D011156:Population Density; D010818:Practice Patterns, Physicians'; D016730:Program Development; D012111:Residence Characteristics; D015912:Thrombolytic Therapy / Q000009:adverse effects; D013997:Time Factors; D014187:Transportation of Patients; D016896:Treatment Outcome
chemical_list: D005343:Fibrinolytic Agents