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Identifying barriers to prehospital thrombolysis in the treatment of acute myocardial infarction
  1. T C Hanson1,
  2. D Williamson2
  1. 1Bristol University Medical School, Bristol, UK
  2. 2Emergency Department, Royal United Hospital, Bath, UK
  1. Correspondence to:
 Dr D Williamson
 Consultant Emergency Medicine, Emergency Department, Royal United Hospital, Combe Park, Bath BA1 3NG, UK; dominic.williamson{at}


Background and objectives: After an acute myocardial infarction (AMI) prehospital thrombolysis (PHT) reduces mortality compared with inhospital thrombolysis. In practice, a relatively small proportion of the total population with AMI receives PHT. This study was designed to identify the current barriers to PHT.

Methods: A retrospective practice review of 57 consecutive patients treated in or before arrival at a district general hospital emergency department. All patients received thrombolysis for an AMI.

Results: The main barriers to delivery of PHT appear to be the inclusion and exclusion criteria laid out in the ambulance service central guidelines. Despite recent widening of the inclusion criteria, 54% of patients eligible for immediate treatment on arrival in hospital either received or were eligible for PHT.

Conclusion: To increase the number of patients who are eligible for PHT these guidelines need to be revised further in line with inhospital criteria for thrombolysis.

  • AMI, acute myocardial infarction
  • CCU, coronary care unit
  • CTN, call to needle time
  • DTN, door to needle time
  • ECG, electrocardiogram
  • ED, emergency department
  • JRCALC, Joint Royal Colleges Ambulance Liaison Committee
  • NICE, National Institute for Health and Clinical Excellence
  • PHT, prehospital thrombolysis
  • prehospital thrombolysis
  • practice review

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  • Competing interests: none declared

  • Ethical approval was not required for this study.

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