Accelerated management of patients with ST-segment elevation myocardial infarction in the ED

• Published in: The American journal of emergency medicine Vol. 29; no. 6; pp. 650 - 655
• Main Authors: Havel, Christof, MD, Schreiber, Wolfgang, MD, Christ, Günter, MD, Winkler, Susanne, MD, Herkner, Harald, MD, MSc
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01-07-2011; Elsevier; Elsevier Limited
• Subjects: Aged; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Angioplasty; Biological and medical sciences; Cardiac Catheterization; Cardiology; Cardiology. Vascular system; Cardiovascular disease; Coronary heart disease; Efficiency, Organizational; Electrocardiography; Emergency; Emergency medical care; Emergency Service, Hospital - organization & administration; Emergency services; Female; Heart; Heart attacks; Humans; Intensive care medicine; Laboratories; Male; Medical sciences; Middle Aged; Myocardial infarction; Myocardial Infarction - therapy; Patients; Prospective Studies; Statistics, Nonparametric; Time Factors; electrocardiogram; PPCI; first medical contact; primary percutaneous coronary intervention; STEMI; ECG; ST-segment elevation myocardial infarction; emergency department; FMC; ED; Human; Myocardial infarction; ST elevation; Intensive care; Clinical management; Cardiovascular disease; Coronary heart disease; Myocardial disease; Resuscitation
• ISSN: 0735-6757; 1532-8171
• DOI: 10.1016/j.ajem.2010.01.037

Abstract Purposes The objective of this study was to evaluate improvement opportunities in the emergency department for timely ST-segment elevation myocardial infarction management and evaluated the new process flow. Basic Procedures In a prospective study, we compared time from door to cath laboratory before and after implementation of a new ST-segment elevation myocardial infarction (STEMI) protocol. The new protocol included a blend of strategies to reduce door to cath laboratory time. Main Findings We included 55 patients. After implementing a new STEMI protocol, we included 54 patients. Time to cath laboratory was 21 (interquartile range, 9-40) minutes before and 10 (interquartile range 5-25) minutes after initiation of the new protocol ( P = .02). A door to cath laboratory time less than 15 minutes was reached in 36% of our patients in phase 1 and in 61% in phase 2 (odds ratio; 0.36, 95% confidence interval, 0.16-0.81; P = .01). Principal Conclusion Simple changes in organizational strategies resulted in a significantly faster care for patients with acute uncomplicated STEMI.