[Outcomes evaluation after the implementation of a pre-hospital thrombolysis protocol in rural areas]. / Evaluación de resultados tras la implantación de un protocolo de fibrinólisis extrahospitalaria en zonas rurales.
Semergen
; 42(7): 440-448, 2016 Oct.
Article
in Es
| MEDLINE
| ID: mdl-26482236
ABSTRACT
INTRODUCTION:
The aim is to evaluate the outcomes obtained from the implementation of a pre-hospital thrombolysis protocol in 3 rural emergency care teams, as well as delays and strategies of reperfusion applied in the treatment of the ST-segment elevation myocardial infarction. MATERIAL ANDMETHODS:
Retrospective cohort study (n=52) with historical control (n=20) of the patients assisted for ST-segment elevation myocardial infarction. Medical emergency care teams, hospital, computerized medical history and ARIAM register reports were revised, obtaining epidemiological and clinical features, off-hospital management, reperfusion, time intervals and mortality.RESULTS:
The baseline features in both groups were not significantly different. There was a non-significant improvement of emergency care teams-hospital diagnostic concordance (85.3 versus 76.9%). We found a similar use of nitroglycerin, morphine and aspirin; significant increase (P<0.0001) of clopidogrel/prasugrel (55 versus 90.4%) and enoxaparin/fondaparinux (35 versus 76.9%), as well as pre-hospital thrombolysis (5 versus 30,8%, P<0.03), that was applied within the first 2h to 71.4%, with a median door-needle of 40min, whereas in-hospital thrombolysis and primary angioplasty were performed after 3h from the symptoms onset (P<0.01). Delays are associated with the patient's own lateness (P<0.02). Pharmaco-invasive strategy increases (62.5 versus 84.6%) more than primary angioplasty (15 versus 17.3%), reducing in-hospital thrombolysis (35 versus 19.2%), all of them non-significant. Complications are similar and one-year mortality is reduced (P<0.67).CONCLUSIONS:
The protocol is effective, safe, and reliable. It reduces delays and improves pre-hospital attention. The pharmaco-invasive strategy is a valid option.Key words
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Rural Health Services
/
Emergency Medical Services
/
Fibrinolytic Agents
/
ST Elevation Myocardial Infarction
Type of study:
Diagnostic_studies
/
Guideline
/
Observational_studies
/
Risk_factors_studies
Limits:
Adult
/
Aged
/
Female
/
Humans
/
Male
/
Middle aged
Country/Region as subject:
Europa
Language:
Es
Journal:
Semergen
Year:
2016
Document type:
Article
Publication country:
ES
/
ESPANHA
/
ESPAÑA
/
SPAIN