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The potential role of the glycoprotein IIb/IIIa blocker tirofiban in the prehospital setting has been investigated in a large multicentre randomised controlled trial. The “On-TIME 2” trial of prehospital tirofiban in patients with ST elevation myocardial infarction who undergo primary coronary intervention has been published in the Lancet. High dose tirofiban alongside the usual treatment of aspirin, heparin and clopidogrel reduced the residual ST elevation at one hour following primary coronary intervention. The study was carried out in Germany, Belgium and The Netherlands, which seem well served by their angiography services, having a median time from tirofiban to angiography of 55 minutes and almost all patients undergoing angiography within 90 minutes of diagnosis (Lancet 2008;372:537–46).


Commotio cordis is a well-recognised cause of sudden death in young people with normal hearts. 90% of cases occur in those under 21 years of age and 50% occur during sporting activities. A commentary in Pediatrics reviews the efficacy of chest wall protectors in preventing ventricular fibrillation. The authors conclude that none of the eight commercially available protectors in …

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