Feasibility and applicability of paramedic-based prehospital fibrinolysis in a large North American center
Although considered the highest level of evidence and critical-to-test novel therapies, clinical trials are unrepresentative of the “real world” as they lack a true patient denominator, which limits general applicability of results. Accordingly, in conjunction with the Assessment of the Safety and E...
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| Veröffentlicht in: | The American heart journal 2006-12, Vol.152 (6), p.1007-1014 |
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| creator | Welsh, Robert C. Travers, Andrew Senaratne, Mano Williams, Randall Armstrong, Paul W. |
| description | Although considered the highest level of evidence and critical-to-test novel therapies, clinical trials are unrepresentative of the “real world” as they lack a true patient denominator, which limits general applicability of results. Accordingly, in conjunction with the Assessment of the Safety and Efficacy of a New Thrombolytic Regimen 3+ trial, we evaluated a comprehensive contemporary cohort of patients with ST segment elevation myocardial infarction (STEMI) to investigate: feasibility, applicability, safety, and efficacy of de novo paramedic-based prehospital fibrinolysis (PHF) program.
Prospective observational comparative cohort of all patients with STEMI encountered during the Assessment of the Safety and Efficacy of a New Thrombolytic Regimen 3+ enrollment period. Time-to-treatment, systematic electrocardiographic (ECG) analysis, peak creatine kinase, inhospital clinical events, and mortality were assessed.
During the 22-month study period, 1095 patients with STEMI were admitted to hospital; 46% (119/258) of eligible patients received PHF (≤6 hours of symptom onset by ambulance). Paramedics contacted the study physician 3.6 times per week: 33% (119/357) of patients enrolled, and ECG transmission failure is 6%. Time-to-treatment was reduced with PHF versus inhospital (1 hour 43 minutes vs 2 hours 38 minutes;
P < .001). Despite higher baseline Thrombolysis in Myocardial Infarction Scores and greater ECG territory at risk (ST), prehospital patients achieved more favorable outcomes: peak creatine kinase (1413 vs 1549 U/L;
P = .122), Q wave at discharge (56.3% vs 70.7%;
P = .003), and intracrainial hemorrhage (0% vs 0.8%;
P < 1.0), respectively. Inhospital mortality for PHF versus inhospital patients was 3.4% versus 4.8% (
P = .627), with an adjusted odds ratio of 0.60 (confidence interval, 0.19-1.87).
Feasibility and applicability of PHF was demonstrated with a substantial reduction in treatment delay and favorable clinical outcomes. Extending the unrealized potential of paramedic-based PHF programs in North America is feasible and desirable. |
| doi_str_mv | 10.1016/j.ahj.2006.06.022 |
| format | Article |
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Prospective observational comparative cohort of all patients with STEMI encountered during the Assessment of the Safety and Efficacy of a New Thrombolytic Regimen 3+ enrollment period. Time-to-treatment, systematic electrocardiographic (ECG) analysis, peak creatine kinase, inhospital clinical events, and mortality were assessed.
During the 22-month study period, 1095 patients with STEMI were admitted to hospital; 46% (119/258) of eligible patients received PHF (≤6 hours of symptom onset by ambulance). Paramedics contacted the study physician 3.6 times per week: 33% (119/357) of patients enrolled, and ECG transmission failure is 6%. Time-to-treatment was reduced with PHF versus inhospital (1 hour 43 minutes vs 2 hours 38 minutes;
P < .001). Despite higher baseline Thrombolysis in Myocardial Infarction Scores and greater ECG territory at risk (ST), prehospital patients achieved more favorable outcomes: peak creatine kinase (1413 vs 1549 U/L;
P = .122), Q wave at discharge (56.3% vs 70.7%;
P = .003), and intracrainial hemorrhage (0% vs 0.8%;
P < 1.0), respectively. Inhospital mortality for PHF versus inhospital patients was 3.4% versus 4.8% (
P = .627), with an adjusted odds ratio of 0.60 (confidence interval, 0.19-1.87).
Feasibility and applicability of PHF was demonstrated with a substantial reduction in treatment delay and favorable clinical outcomes. Extending the unrealized potential of paramedic-based PHF programs in North America is feasible and desirable.</description><identifier>ISSN: 0002-8703</identifier><identifier>EISSN: 1097-6744</identifier><identifier>DOI: 10.1016/j.ahj.2006.06.022</identifier><identifier>PMID: 17161044</identifier><identifier>CODEN: AHJOA2</identifier><language>eng</language><publisher>New York, NY: Mosby, Inc</publisher><subject>Acute coronary syndromes ; Aged ; Allied Health Personnel ; Ambulances ; Biological and medical sciences ; Blood pressure ; Cardiology. Vascular system ; Cardiovascular disease ; Cerebral Hemorrhage - chemically induced ; Cerebral Hemorrhage - epidemiology ; Cohort Studies ; Creatine Kinase - blood ; Diabetes ; Electrocardiography ; Emergency Medical Technicians ; Feasibility Studies ; Female ; Heart attacks ; Heart rate ; Hospital Mortality ; Hospitalization ; Hospitals ; Humans ; Incidence ; Intubation ; Ischemia ; Kinases ; Male ; Medical sciences ; Middle Aged ; Mortality ; Myocardial Infarction - blood ; Myocardial Infarction - diagnosis ; Myocardial Infarction - drug therapy ; Myocardial Infarction - physiopathology ; North America ; Prospective Studies ; Thrombolytic Therapy - adverse effects ; Time Factors ; Treatment Outcome</subject><ispartof>The American heart journal, 2006-12, Vol.152 (6), p.1007-1014</ispartof><rights>2006 Mosby, Inc.</rights><rights>2007 INIST-CNRS</rights><rights>Copyright Elsevier Limited Dec 2006</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c409t-ddf962579ac3ca37d0d470f6f6d9d00fc519c6c4a2ff1a3dfbf547ed01baa9093</citedby><cites>FETCH-LOGICAL-c409t-ddf962579ac3ca37d0d470f6f6d9d00fc519c6c4a2ff1a3dfbf547ed01baa9093</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.proquest.com/docview/1504612859?pq-origsite=primo$$EHTML$$P50$$Gproquest$$H</linktohtml><link.rule.ids>314,780,784,3550,27924,27925,45995,64385,64389,72469</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=18418683$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/17161044$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Welsh, Robert C.</creatorcontrib><creatorcontrib>Travers, Andrew</creatorcontrib><creatorcontrib>Senaratne, Mano</creatorcontrib><creatorcontrib>Williams, Randall</creatorcontrib><creatorcontrib>Armstrong, Paul W.</creatorcontrib><title>Feasibility and applicability of paramedic-based prehospital fibrinolysis in a large North American center</title><title>The American heart journal</title><addtitle>Am Heart J</addtitle><description>Although considered the highest level of evidence and critical-to-test novel therapies, clinical trials are unrepresentative of the “real world” as they lack a true patient denominator, which limits general applicability of results. Accordingly, in conjunction with the Assessment of the Safety and Efficacy of a New Thrombolytic Regimen 3+ trial, we evaluated a comprehensive contemporary cohort of patients with ST segment elevation myocardial infarction (STEMI) to investigate: feasibility, applicability, safety, and efficacy of de novo paramedic-based prehospital fibrinolysis (PHF) program.
Prospective observational comparative cohort of all patients with STEMI encountered during the Assessment of the Safety and Efficacy of a New Thrombolytic Regimen 3+ enrollment period. Time-to-treatment, systematic electrocardiographic (ECG) analysis, peak creatine kinase, inhospital clinical events, and mortality were assessed.
During the 22-month study period, 1095 patients with STEMI were admitted to hospital; 46% (119/258) of eligible patients received PHF (≤6 hours of symptom onset by ambulance). Paramedics contacted the study physician 3.6 times per week: 33% (119/357) of patients enrolled, and ECG transmission failure is 6%. Time-to-treatment was reduced with PHF versus inhospital (1 hour 43 minutes vs 2 hours 38 minutes;
P < .001). Despite higher baseline Thrombolysis in Myocardial Infarction Scores and greater ECG territory at risk (ST), prehospital patients achieved more favorable outcomes: peak creatine kinase (1413 vs 1549 U/L;
P = .122), Q wave at discharge (56.3% vs 70.7%;
P = .003), and intracrainial hemorrhage (0% vs 0.8%;
P < 1.0), respectively. Inhospital mortality for PHF versus inhospital patients was 3.4% versus 4.8% (
P = .627), with an adjusted odds ratio of 0.60 (confidence interval, 0.19-1.87).
Feasibility and applicability of PHF was demonstrated with a substantial reduction in treatment delay and favorable clinical outcomes. Extending the unrealized potential of paramedic-based PHF programs in North America is feasible and desirable.</description><subject>Acute coronary syndromes</subject><subject>Aged</subject><subject>Allied Health Personnel</subject><subject>Ambulances</subject><subject>Biological and medical sciences</subject><subject>Blood pressure</subject><subject>Cardiology. Vascular system</subject><subject>Cardiovascular disease</subject><subject>Cerebral Hemorrhage - chemically induced</subject><subject>Cerebral Hemorrhage - epidemiology</subject><subject>Cohort Studies</subject><subject>Creatine Kinase - blood</subject><subject>Diabetes</subject><subject>Electrocardiography</subject><subject>Emergency Medical Technicians</subject><subject>Feasibility Studies</subject><subject>Female</subject><subject>Heart attacks</subject><subject>Heart rate</subject><subject>Hospital Mortality</subject><subject>Hospitalization</subject><subject>Hospitals</subject><subject>Humans</subject><subject>Incidence</subject><subject>Intubation</subject><subject>Ischemia</subject><subject>Kinases</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Mortality</subject><subject>Myocardial Infarction - blood</subject><subject>Myocardial Infarction - diagnosis</subject><subject>Myocardial Infarction - drug therapy</subject><subject>Myocardial Infarction - physiopathology</subject><subject>North America</subject><subject>Prospective Studies</subject><subject>Thrombolytic Therapy - adverse effects</subject><subject>Time Factors</subject><subject>Treatment Outcome</subject><issn>0002-8703</issn><issn>1097-6744</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2006</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>8G5</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><sourceid>GUQSH</sourceid><sourceid>M2O</sourceid><recordid>eNp9kE1r3DAQhkVoSTZpf0AvQVBytDuSZdmmp7DkC0J6ac9irI-ujNd2JG9g_31l1rC3wsAw4pl3xEPINwY5AyZ_dDnuupwDyHwpzi_IhkFTZbIS4hPZAADP6gqKK3IdY5dGyWt5Sa5YxSQDITake7QYfet7Px8pDobiNPVe4_oyOjphwL01XmctRmvoFOxujJOfsafOt8EPY3-MPlI_UKQ9hr-Wvo1h3tH7vQ0paqDaDrMNX8hnh320X9d-Q_48PvzePmevv55etvevmRbQzJkxrpG8rBrUhcaiMmBEBU46aRoD4HTJGi21QO4cw8K41pWisgZYi9hAU9yQ76fcKYzvBxtn1Y2HMKSTipUgJON1uVDsROkwxhisU1PwewxHxUAtdlWnkl212FVLcZ52btfkQ5uUnDdWnQm4WwGMGnsXcNA-nrlasFrWReJ-njibPHx4G1TU3g46aQ5Wz8qM_j_f-Af5MZkI</recordid><startdate>20061201</startdate><enddate>20061201</enddate><creator>Welsh, Robert C.</creator><creator>Travers, Andrew</creator><creator>Senaratne, Mano</creator><creator>Williams, Randall</creator><creator>Armstrong, Paul W.</creator><general>Mosby, Inc</general><general>Elsevier</general><general>Elsevier Limited</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7QO</scope><scope>7RV</scope><scope>7TS</scope><scope>7X7</scope><scope>7XB</scope><scope>88C</scope><scope>88E</scope><scope>8AO</scope><scope>8C1</scope><scope>8FD</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>8G5</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AN0</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M0T</scope><scope>M1P</scope><scope>M2O</scope><scope>MBDVC</scope><scope>NAPCQ</scope><scope>P64</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>Q9U</scope></search><sort><creationdate>20061201</creationdate><title>Feasibility and applicability of paramedic-based prehospital fibrinolysis in a large North American center</title><author>Welsh, Robert C. ; Travers, Andrew ; Senaratne, Mano ; Williams, Randall ; Armstrong, Paul W.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c409t-ddf962579ac3ca37d0d470f6f6d9d00fc519c6c4a2ff1a3dfbf547ed01baa9093</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2006</creationdate><topic>Acute coronary syndromes</topic><topic>Aged</topic><topic>Allied Health Personnel</topic><topic>Ambulances</topic><topic>Biological and medical sciences</topic><topic>Blood pressure</topic><topic>Cardiology. Vascular system</topic><topic>Cardiovascular disease</topic><topic>Cerebral Hemorrhage - chemically induced</topic><topic>Cerebral Hemorrhage - epidemiology</topic><topic>Cohort Studies</topic><topic>Creatine Kinase - blood</topic><topic>Diabetes</topic><topic>Electrocardiography</topic><topic>Emergency Medical Technicians</topic><topic>Feasibility Studies</topic><topic>Female</topic><topic>Heart attacks</topic><topic>Heart rate</topic><topic>Hospital Mortality</topic><topic>Hospitalization</topic><topic>Hospitals</topic><topic>Humans</topic><topic>Incidence</topic><topic>Intubation</topic><topic>Ischemia</topic><topic>Kinases</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Mortality</topic><topic>Myocardial Infarction - blood</topic><topic>Myocardial Infarction - diagnosis</topic><topic>Myocardial Infarction - drug therapy</topic><topic>Myocardial Infarction - physiopathology</topic><topic>North America</topic><topic>Prospective Studies</topic><topic>Thrombolytic Therapy - adverse effects</topic><topic>Time Factors</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Welsh, Robert C.</creatorcontrib><creatorcontrib>Travers, Andrew</creatorcontrib><creatorcontrib>Senaratne, Mano</creatorcontrib><creatorcontrib>Williams, Randall</creatorcontrib><creatorcontrib>Armstrong, Paul W.</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Biotechnology Research Abstracts</collection><collection>Nursing & Allied Health Database</collection><collection>Physical Education Index</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Healthcare Administration Database (Alumni)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Public Health Database</collection><collection>Technology Research Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>Research Library (Alumni Edition)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>British Nursing Database</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Engineering Research Database</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>Research Library Prep</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Healthcare Administration Database</collection><collection>Medical Database</collection><collection>Research Library</collection><collection>Research Library (Corporate)</collection><collection>Nursing & Allied Health Premium</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>ProQuest Central Basic</collection><jtitle>The American heart journal</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Welsh, Robert C.</au><au>Travers, Andrew</au><au>Senaratne, Mano</au><au>Williams, Randall</au><au>Armstrong, Paul W.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Feasibility and applicability of paramedic-based prehospital fibrinolysis in a large North American center</atitle><jtitle>The American heart journal</jtitle><addtitle>Am Heart J</addtitle><date>2006-12-01</date><risdate>2006</risdate><volume>152</volume><issue>6</issue><spage>1007</spage><epage>1014</epage><pages>1007-1014</pages><issn>0002-8703</issn><eissn>1097-6744</eissn><coden>AHJOA2</coden><abstract>Although considered the highest level of evidence and critical-to-test novel therapies, clinical trials are unrepresentative of the “real world” as they lack a true patient denominator, which limits general applicability of results. Accordingly, in conjunction with the Assessment of the Safety and Efficacy of a New Thrombolytic Regimen 3+ trial, we evaluated a comprehensive contemporary cohort of patients with ST segment elevation myocardial infarction (STEMI) to investigate: feasibility, applicability, safety, and efficacy of de novo paramedic-based prehospital fibrinolysis (PHF) program.
Prospective observational comparative cohort of all patients with STEMI encountered during the Assessment of the Safety and Efficacy of a New Thrombolytic Regimen 3+ enrollment period. Time-to-treatment, systematic electrocardiographic (ECG) analysis, peak creatine kinase, inhospital clinical events, and mortality were assessed.
During the 22-month study period, 1095 patients with STEMI were admitted to hospital; 46% (119/258) of eligible patients received PHF (≤6 hours of symptom onset by ambulance). Paramedics contacted the study physician 3.6 times per week: 33% (119/357) of patients enrolled, and ECG transmission failure is 6%. Time-to-treatment was reduced with PHF versus inhospital (1 hour 43 minutes vs 2 hours 38 minutes;
P < .001). Despite higher baseline Thrombolysis in Myocardial Infarction Scores and greater ECG territory at risk (ST), prehospital patients achieved more favorable outcomes: peak creatine kinase (1413 vs 1549 U/L;
P = .122), Q wave at discharge (56.3% vs 70.7%;
P = .003), and intracrainial hemorrhage (0% vs 0.8%;
P < 1.0), respectively. Inhospital mortality for PHF versus inhospital patients was 3.4% versus 4.8% (
P = .627), with an adjusted odds ratio of 0.60 (confidence interval, 0.19-1.87).
Feasibility and applicability of PHF was demonstrated with a substantial reduction in treatment delay and favorable clinical outcomes. Extending the unrealized potential of paramedic-based PHF programs in North America is feasible and desirable.</abstract><cop>New York, NY</cop><pub>Mosby, Inc</pub><pmid>17161044</pmid><doi>10.1016/j.ahj.2006.06.022</doi><tpages>8</tpages></addata></record> |
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| subjects | Acute coronary syndromes Aged Allied Health Personnel Ambulances Biological and medical sciences Blood pressure Cardiology. Vascular system Cardiovascular disease Cerebral Hemorrhage - chemically induced Cerebral Hemorrhage - epidemiology Cohort Studies Creatine Kinase - blood Diabetes Electrocardiography Emergency Medical Technicians Feasibility Studies Female Heart attacks Heart rate Hospital Mortality Hospitalization Hospitals Humans Incidence Intubation Ischemia Kinases Male Medical sciences Middle Aged Mortality Myocardial Infarction - blood Myocardial Infarction - diagnosis Myocardial Infarction - drug therapy Myocardial Infarction - physiopathology North America Prospective Studies Thrombolytic Therapy - adverse effects Time Factors Treatment Outcome |
| title | Feasibility and applicability of paramedic-based prehospital fibrinolysis in a large North American center |
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