Faculty Collaboration Database

Feasibility of prehospital r-TPA therapy in chest pain patients. Ann Emerg Med 1992 Apr;21(4):379-83

Date

04/01/1992

Pubmed ID

1554174

DOI

10.1016/s0196-0644(05)82654-x

Scopus ID

2-s2.0-0026608159 (requires institutional sign-in at Scopus site)   29 Citations

Abstract

STUDY OBJECTIVE: The purpose of this study was to determine the number of eligible prehospital thrombolytic candidates and to estimate the potential time saved if field thrombolysis had been initiated in a series of prehospital chest pain patients.

DESIGN AND SETTING: Prehospital 12-lead ECGs were obtained by paramedics during initial evaluation of chest pain patients and stored in the computerized ECG. Prehospital 12-lead ECGs, prehospital charts, and hospital charts then were reviewed retrospectively for final hospital diagnosis, prehospital and emergency department times, and historical exclusion criteria for prehospital treatment with recombinant tissue-type plasminogen activator (r-TPA).

TYPE OF PARTICIPANTS: One hundred fifty-seven stable adult prehospital patients with a chief complaint of nontraumatic chest pain were enrolled. Six patients were excluded. Two had unretrievable 12-lead ECGs, and four refused paramedic transport and thus provided no further data. There were complete data on 151 patients making up the final study population.

INTERVENTIONS: Prehospital care was unaltered except for acquisition of 12-lead ECGs. No prehospital thrombolytic therapy was administered during this study.

MEASUREMENTS AND MAIN RESULTS: The incidence of r-TPA exclusion criteria was as follows: 45 patients (29%) were 75 years of age or older, 57 (38%) had chest pain for more than six hours, 24 (16%) had hypertension with blood pressure of more than 180/110 mm Hg, and six (4%) had a history of a cerebrovascular accident. The time from paramedic scene arrival to prehospital ECG (8.4 +/- 5.1 minutes) was significantly shorter than the time from ED arrival to ED ECG (24.2 +/- 21.6 minutes, P less than .001). Prehospital ECGs increased paramedic scene time over a retrospective control by 5.2 minutes. Mean time from prehospital ECG to ED ECG (potential time saved) was 50.2 + 22.4 minutes in all patients and 43.4 +/- 7.7 minutes in patients with a final diagnosis of acute myocardial infarction (P = NS). Thirteen of 151 patients (8.6%) had prehospital ECGs diagnostic for acute myocardial infarction; eight of these (5.3% overall) met criteria for prehospital r-TPA therapy.

CONCLUSION: Prehospital 12-lead ECGs provide an ECG diagnosis 40 to 50 minutes earlier than ED ECGs. However, with current exclusion criteria, the number of prehospital r-TPA candidates is limited.

Author List

Aufderheide TP, Haselow WC, Hendley GE, Robinson NA, Armaganian L, Hargarten KM, Olson DW, Valley VT, Stueven HA

Author

Tom P. Aufderheide MD Professor in the Emergency Medicine department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Aged
Chest Pain
Electrocardiography
Emergencies
Emergency Medical Services
Female
Humans
Male
Middle Aged
Myocardial Infarction
Retrospective Studies
Time Factors
Tissue Plasminogen Activator