Abstract 2403: Effect Of Prehospital Cath Lab Activation On Door To Balloon Time Of STEMI Patients Presenting During Normal Workday Hours vs. After Hours

Abstract

BACKGROUND : We significantly reduced door-to-balloon-time (DBT) after instituting prehospital cath lab activation for STEMI, without EKG transmittal or MD involvement. OBJECTIVE: To study the effect of the protocol on DBT in normal workday hours (cath lab team is in-house) vs. after-hours (cath lab team is not in-house). METHODS : For all STEMI patients (pts), data are collected prospectively. Since 2001 all pts transported by our institution’s EMS, with symptoms suggesting MI, have had prehospital EKG. In April 2005, we started the following additional protocol (with no other changes in our acute MI program): if the chief complaint is Chest Pain and the Zoll® M Series Interpretive EKG (Marquette 12SL algorithm) reads ``**Acute MI**,” Paramedics call the ED unit coordinator from the scene to activate the cath lab without MD involvement. For all EMS transported pts from Jan 2004 to Jan 2007, we analyzed demographics, symptoms, Zoll interpretation, door-to-EKG-time, and DBT. We compared the time saved before and after protocol change for normal workday hours vs. after hours. Statistics were by Kruskal Wallis and the two-tailed Fisher Exact test. RESULTS: There were 104 patients with STEMI transported in the time period. 36 were excluded: 26 with no chest pain (14 cardiac arrest), 8 with a non-diagnostic Zoll EKG and 2 others. Of 68 eligible patients (65% of all STEMI), 36 had prehospital activation (20 workday, 16 after hours) and 32 did not get prehospital activation (12 Workday and 20 after hours). See table for results. Overall mean DBT was reduced from 86.0 ± 9.6 (CI) min. in the before group to 56.1 ± 7.7 min. in the prehospital activation group. CONCLUSION : Prehospital activation significantly reduces DBT in STEMI patients presenting during both normal workday hours and after hours. Significant time savings and exceptionally short DBTs (< 60 min) were achieved by prehospital activation for STEMI patients presenting during normal workday hours.