PREHOSPITAL CARE
Paramedic-led prehospital thrombolysis is safe and effective: the East Anglian experience
1 Department of Cardiology, Papworth Hospital, Cambridge, UK
2 East of England Ambulance Service NHS Trust, Bury St Edmunds, Suffolk, UK
3 MRC Biostatistics Unit, Cambridge, UK
Correspondence to:
Dr P M Schofield, Department of Cardiology, Papworth Hospital, Papworth Everard, Cambridge CB3 8RE, UK; Peter.Schofield{at}papworth.nhs.uk
Introduction: Prehospital thrombolysis has been shown to improve patient outcomes in clinical trials and this has been confirmed in the ongoing large national myocardial infarction registry (Myocardial Infarction National Audit Project; MINAP) reports. This paper describes a system to improve the delivery of prehospital thrombolysis and the associated governance requirements to gain maximum patient benefit.
Methods: Demographic data were prospectively collected on all patients treated by the East Anglian Ambulance Trust with bolus thrombolytics for a presumed diagnosis of ST elevation myocardial infarction between November 2003 and February 2007. Survival status was determined from the NHS strategic tracing service.
Results: 1062 patients (mean age 64.0 years (SD 10.6), 795 men) were treated in this time period. There were 71 deaths in this group, with actuarial survival of 93.9% (SE 0.9%) at 30 days, 91.7% (SE 1.0%) at 6 months and 90.8% (SE 1.1%) at 12 months after treatment. Age and cardiac arrest were most strongly associated with mortality (both p<0.001). Twelve (1.2%) patients received thrombolysis that on review was considered inappropriate. There were no deaths in this subgroup.
Conclusions: Prehospital thrombolysis can be administered safely by ambulance staff supported by a Trust clinical support system with excellent clinical outcomes.
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