The Impact of Paramedics Identifying STEMI Patients & Transport PCI Centers - @

The Impact of Paramedics Identifying STEMI Patients & Transport PCI Centers

Street Science


Keith Wesley | | Tuesday, June 26, 2007

Review of: Le May MR, Davies RF, Dionne R, et al: "Comparison of early mortality of paramedic-diagnosed ST-segment elevation myocardial infarction with immediate transport to a designated primary percutaneous coronary intervention center to that of similar patients transported to the nearest hospital." The American Journal of Cardiology. 98(10):1329-33, 2006

The Science

This study conducted in Ottawa, Canada, examined the impact of paramedics identifying ST-segment elevation myocardial infarction (STEMI) patients and the transport of these patients to the nearest primary percutaneous coronary intervention (PCI) center. The authors compared outcomes of similar patients who during the two years previous to the study were transported to the nearest hospital and received thrombolytics (control group).

Paramedics were educated to recognize STEMI on 12-lead ECGs and alert the only PCI center in the city of the patient s impending arrival. They treated 108 consecutive STEMI patients. PCI was performed on 93.5% of the study group and only 8.9% of the control group. Median door-to-balloon time was 63 minutes. In-hospital mortality was 1.9% in the "paramedic-referred PCI" group and 8.9% in the control group.

The Street

While at first blush when reading the abstract and the title, one would assume that this is a paper that resoundingly supports the adoption of prehospital 12-lead acquisition and preferred routing of patients to PCI centers. However, let s look more closely at it.

First of all, the control group is composed of patients who over a two-year period (before the study began) taken to the nearest facility for treatment of suspected STEMI. It is unknown whether they received prehospital 12-leads. They were all taken to a facility that performed few PCI at that time. It is unknown what happened to the patients that were transported to the study facility during this time and whether or not they were identified by 12-lead.

Then the study facility started doing 12-leads and all STEMIs were taken to it. It is unknown what happened to patients who continued to be taken to non PCI facilities.

Clearly, there were better outcomes as far as mortality is considered between the historical controls who got thrombolytics and those that got PCI. However, further analysis of the PCI group shows that half the patients had statistically significant delays in getting to the cath lab when they arrived "after hours." Mean door-to-balloon time was 39 minutes during the day and 81 minutes at night. There is no further discussion of the difference in mortality between these two groups. Even so, the patients who had delayed PCI had a door-to-balloon time 45 minutes shorter than the historical controls.

While other studies have proven the feasibility of prehospital identification of STEMI, this study is more an evaluation of the effect of instituting PCI in a system and comparing it to their previous experience with thrombolytics. A true test of PCI vs. thrombolytics would be to have the patients randomly assigned to one hospital or another. However, recent studies indicate that primary PCI is superior to thombolytics.

While I congratulate the authors on their results, it is important to recognize that the benefit to the patient came primarily with the advancement of PCI but could not have been successful had it not been for the ability of the paramedics to identify quality candidates.

Connect: Have a thought or feedback about this? Add your comment now
Related Topics: Cardiac and Circulation, Research

What's Your Take? Comment Now ...

Buyer's Guide Featured Companies

Featured Careers & Jobs in EMS

Get JEMS in Your Inbox


Fire EMS Blogs

Blogger Browser

Today's Featured Posts


EMS Airway Clinic

Improving Survival from Cardiac Arrest Using ACD-CPR + ITD

Using active compression-decompression CPR with an ITD has been shown to improve 1-year survival from cardiac arrest by 33%.
More >

Multimedia Thumb

Explosion Shakes Mexico Hospital

Rescuers search ruins of children’s hospital.
More >

Multimedia Thumb

Hands On February 2015

Here’s a look at this month’s product hands on.
More >

Multimedia Thumb

Nightwatch Series Premiere Party

JEMS Editor-in-Chief A.J. Heightman attends the series premiere of A&E's new reality show, "Nightwatch."
More >

Multimedia Thumb

The AmbuBus®, Bus Stretcher Conversion Kit - EMS Today 2013

AmbuBus®, Bus Stretcher all-hazards preparedness & response tool
Watch It >

Multimedia Thumb

Field Bridge Xpress ePCR on iPad, Android, Kindle Fire

Sneak peek of customizable run forms & more.
Watch It >

Multimedia Thumb

Braun Ambulances' EZ Door Forward

Helps to create a safer ambulance module.
Watch It >

More Product Videos >