Chest
Clinical InvestigationsPrehospital Coronary Thrombolysis: A New Strategy in Acute Myocardial Infarction
Section snippets
Mobile Intensive Care Unit
Jerusalem has a population of 500,000 and an area of 100 km2. It is served by a central ambulance station located at the apex of the major transcity highway system. A 24-hour physician operated ambulance known as the Mobile Intensive Care Unit (MICU) was established in 1972, and the city population has been educated to call it for any major emergency including prolonged chest pain or sudden collapse. The patient calls the ambulance station directly and a trained dispatcher sends the MICU to the
Prehospital Streptokinase
We treated 34 patients in the prehospital phase. There were 31 men and three women ranging in age from 37 to 75 years with a mean of 56±11 years. Twenty-nine had a first infarct and five had experienced a previous infarct. Thirteen had an anterior and 21 an inferior infarct.
The time from the onset of chest pain to MICU notification call was 33±19 minutes, and the ambulance arrival time was 5±3 minutes. The MICU team spent 25±10 minutes in making the diagnosis, assessing the effect of isosorbide
Discussion
The shortterm and longterm prognosis after acute myocardial infarction—mortality and quality of life—depend on infarct size and the degree of ventricular dysfunction. The purpose of this study was to reduce the time of ischemia by administering streptokinase prior to hospital admission, to demonstrate the functional importance of such early treatment in myocardial salvage, and to document its safety. The average time to the infusion of streptokinase was 1.0±0.4 hours. No other group has
Conclusions
This study has shown that prehospital streptokinase infusion is feasible, practical, and relatively safe. By eliminating delays due to transport, hospital triage, and reevaluation, this strategy reduces the time from symptom onset to treatment initiation to a minimum. Because infarct size and preservation of cardiac function are clearly related to duration of ischemia, institution of this strategy in places where these delays are greatest will have the greatest impact.
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Cited by (45)
Acute coronary syndromes
2001, Annals of Emergency MedicineAccuracy and clinical effect of out-of-hospital electrocardiography in the diagnosis of acute cardiac ischemia: A meta-analysis
2001, Annals of Emergency MedicineCitation Excerpt :In-hospital mortality was 8% in the out-of-hospital group versus 12% in the control group (P <.001), and the survival benefit persisted after adjusting for various predictors of mortality. Prospective nonrandomized evidence was available from 4 different teams (Table 3).29-34 Characteristics of prospective nonrandomized studies of out-of-hospital thrombolysis.
Prevention of congestive heart failure by early, prehospital thrombolysis in acute myocardial infarction: A long-term follow-up study
1998, International Journal of CardiologyThrombolysis in acute myocardial infarction improves prognosis and prolongs life but will increase the prevalence of heart failure in the geriatric population
1998, International Journal of CardiologyChanging paradigms in thrombolysis in acute myocardial infarction
1997, International Journal of Cardiology
This study was supported by a grant from the Hadassah Associates, Los Angeles, California.
Manuscript received July 7; revision accepted October 16.