有限的证据支持初级护理护理人员(PCP)直接运输ST段抬高型心肌梗死(STEMI)患者进行经皮冠状动脉介入治疗(PCI)。这项研究的目的是评估基于城市的PCPSTEMI旁路指南。
我们回顾了2015年4月7日至2016年5月31日之间关于PCP确定的STEMI患者的连续多伦多护理人员服务呼叫报告。主要结果是根据指南标准的患者分配(稳定与不稳定)。次要结局是PCP转运患者中有高级护理干预(ACI)的指征或PCP与高级护理护理人员(ACP)会诊时接受ACI的比例。最后,我们回顾了心脏骤停患者的院前结局,并计算了直接PCP搭桥术与PCI中心之间的转运间隔时间的差异,以及到最近急诊科(ED)的预计转运间隔时间.
361名患者中,232个是PCP运输,129个是ACP会合运输。稳定和不稳定患者在PCPs和ACPs之间的分布存在显着差异(p<0.001)。对于PCP患者,21/232(9.1%)有ACI适应症,而34/129(26.4%)ACP患者接受ACI。11例患者经历了心脏骤停;10例成功复苏(其中5例通过PCP)。直接PCP旁路和PCI中心与运输到最接近ED之间的中位数差异为5.53分钟(IQR=6.71)。
我们发现PCP患者中稳定和不稳定患者的分布有显著差异,有ACI适应症的患者较少。此PCPSTEMI旁路指南似乎是可行的。
Limited evidence supports primary care paramedic (PCP) direct transport of ST-segment elevation myocardial infarction (STEMI) patients for percutaneous coronary intervention (PCI). The goal of this study was to evaluate an urban-based PCP STEMI bypass
guideline.
We reviewed consecutive Toronto Paramedic Services call reports between April 7, 2015, and May 31, 2016, regarding STEMI patients identified by PCPs. The primary outcome was patient assignment (stable versus unstable) according to
guideline criteria. Secondary outcomes were the proportion of PCP-transported patients who had an indication for an advanced care intervention (ACI) or who received an ACI when PCPs rendezvoused with an advanced care paramedic (ACP). Lastly, we reviewed prehospital outcomes of cardiac arrest patients and calculated the difference in transport intervals between direct PCP bypass and a PCI-centre and predicted transport interval to the closest emergency department (ED).
Of 361 patients, 232 were PCP transports and 129 were ACP-rendezvous transports. There was a significant difference in the distribution of stable and unstable patients between PCPs and ACPs (p<0.001). For PCP patients, 21/232 (9.1%) had indications for an ACI, whereas 34/129 (26.4%) ACP patients received an ACI. Eleven patients experienced cardiac arrest; 10 were successfully resuscitated (5 of these by PCPs). The median difference between direct PCP bypass and a PCI-centre versus transport to the closest ED was 5.53 minutes (IQR=6.71).
We found a significant difference in the distribution of stable and unstable patients and fewer patients with indications for an ACI in PCP patients. This PCP STEMI bypass
guideline appears feasible.