Prehospital use of APSAC: Results of a placebo-controlled study
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Cited by (117)
European Resuscitation Council Guidelines for Resuscitation 2015 Section 8. Initial management of acute coronary syndromes
2015, ResuscitationCitation Excerpt :Fibrinolysis is effective specifically in the first 2 to 3 h after symptom onset; PPCI is less time sensitive. A meta-analysis of 3 RCTs including 531 patients showed benefit of prehospital versus inhospital fibrinolysis in terms of survival to hospital discharge without evidence of additional harm in terms of major or intracranial bleeding.123–125 An effective and safe system for out-of-hospital fibrinolytic therapy requires adequate facilities for the diagnosis and treatment of STEMI and its complications.
Part 5: Acute coronary syndromes. 2015 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations
2015, ResuscitationCitation Excerpt :For the critical outcome of intracranial hemorrhage, we have identified low-quality evidence (downgraded for risk of bias and imprecision) from 2 RCTs74,75 enrolling 438 patients showing no additional harm from prehospital fibrinolysis compared with in-hospital fibrinolysis (OR, 2.14; 95% CI, 0.39–11.84). For the important outcome of bleeding, we have identified low-quality evidence (downgraded for imprecision) from 2 RCTS74,75 enrolling 438 patients showing no additional harm from prehospital fibrinolysis compared with in-hospital fibrinolysis (OR, 0.96; 95% CI, 0.40–2.32). For other outcomes (revascularization, reinfarction, and ischemic stroke), no evidence from RCTs was found.
2013 ACCF/AHA guideline for the management of st-elevation myocardial infarction: A report of the American college of cardiology foundation/american heart association task force on practice guidelines
2013, Journal of the American College of CardiologyPart 9: Acute coronary syndromes: 2010 International consensus on cardiopulmonary resuscitation and emergency cardiovascular care science with treatment recommendations
2010, ResuscitationCitation Excerpt :In patients with STEMI in the prehospital setting, does the use of prehospital fibrinolytics, compared with in-hospital fibrinolytics, improve outcomes (e.g., chest pain resolution, infarct size, ECG resolution, survival to discharge, 30/60 days mortality)? Nineteen studies demonstrated significantly reduced time to treatment when fibrinolytics were given to patients with STEMI in the prehospital setting by either physicians, nurses, or paramedics (LOE 1496,497,498,499–501 LOE 2124,502–510; LOE 3511–513). Eleven studies showed that a greater proportion of the patients treated with prehospital fibrinolysis had shorter duration and increased frequency of total resolution of chest pain by the time of admission, ECG resolution, and decreased mortality (LOE 1496,499,500,514–516; LOE 2505,506,508,511,513).
Acute ST-segment elevation myocardial infarction: American College of Chest Physicians evidence-based clinical practice guidelines (8th edition)
2008, ChestCitation Excerpt :Another nonrandomized, observational study48 in 6,891 patients ≥ 75 years old with first registry-recorded STE MI also confirm an overall survival advantage to fibrinolysis in the elderly. Several randomized trials49–54 of prehospital- initiated fibrinolysis have provided important insights regarding the impact of early treatment (Tables 4, 5). Indeed, acquisition of 12-lead ECGs in the field and the use of a reperfusion checklist (Fig 1)6 could lead to more rapid prehospital and hospital care.54,55
The Role of Fibrinolytics in the Prehospital Treatment of ST-Elevation Myocardial Infarction (STEMI)
2008, Journal of Emergency MedicineCitation Excerpt :This strategy has been shown to improve clinical outcome and reduce mortality, and is feasible in rural and urban locations. It should be noted that many of the studies that demonstrate benefits with prehospital fibrinolysis (as shown in Table 1) were conducted in Europe and Israel, where a physician was included in the ambulance personnel, which is not usual practice in the United States (15–21,26,27). However, the two North American studies and one Swedish study in which prehospital fibrinolysis was administered by paramedics also showed improvements in time to treatment initiation, with comparable or better outcomes compared with in-hospital treatment (24,29,30).