Pre-hospital electrocardiogram triage with tele-cardiology support is associated with shorter time-to-balloon and higher rates of timely reperfusion even in rural areas: data from the Bari- Barletta/Andria/Trani public emergency medical service 118 registry on primary angioplasty in ST-elevation myocardial infarction

Abstract Background In the region of South Limburg, the Netherlands, a shared ST-elevation myocardial infarction (STEMI) networking system (SLIM network) was implemented. During out-of-office hours, two percutaneous coronary intervention (PCI) centres—Maastricht University Medical Centre and Zuyderland Medical Centre—are supported by the same interventional cardiologist. The aim of this study was to analyse performance indicators within this network and to compare them with contemporary European Society of Cardiology guidelines. Methods Key time indicators for an all-comer STEMI population were registered by the emergency medical service and the PCI centres. The time measurements showed a non-Gaussian distribution; they are presented as median with 25th and 75th percentiles. Results Between 1 February 2018 and 31 March 2019, a total of 570 STEMI patients were admitted to the participating centres. The total system delay (from emergency call to needle time) was 65 min (53–77), with a prehospital system delay of 40 min (34–47) and a door-to-needle time of 22 min (15–34). Compared with in-office hours, out-of-office hours significantly lengthened system delays (55 (47–66) vs 70 min (62–81), p < 0.001), emergency medical service transport times (29 (24–34) vs 35 min (29–40), p < 0.001) and door-to-needle times (17 (14–26) vs 26 min (18–37), p < 0.001). Conclusions With its effective patient pathway management, the SLIM network was able to meet the quality criteria set by contemporary European revascularisation guidelines.

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Emergency medical service evaluations for chest pain during the COVID-19 lockdown in Hollands-Midden, the Netherlands

10.21203/rs.3.rs-100573/v1 ◽

2020 ◽

Author(s):

Enrico de Koning ◽

Mark Boogers ◽

Jan Bosch ◽

Matthijs de Visser ◽

Martin Schalij ◽

...

Keyword(s):

Myocardial Infarction ◽

Chest Pain ◽

Emergency Medical Service ◽

Medical Service ◽

Relative Risk Reduction ◽

Cardiac Symptoms ◽

Emergency Medical ◽

St Elevation ◽

Pain Patients ◽

Hospital Cardiac Arrest

Abstract Objective: To assess whether the COVID-19 lockdown might have had negative indirect health effects, as people seem to have been reluctant to seek medical care. Methods: All emergency medical service (EMS) rides for chest pain and out-of-hospital cardiac arrest (OHCA) in the Dutch region Hollands-Midden (population served >800.000) were evaluated during the initial 6 weeks of the COVID-19 lockdown and compared to the same period in 2019 in two cohorts. The primary end-point was the incidence of evaluated chest pain patients during the COVID-19 lockdown. In addition, the incidence of EMS evaluations of ST elevation myocardial infarction (STEMI) and OHCA were assessed.Results: During the COVID-19 lockdown period, the EMS evaluated 927 chest pain patients (49% male, 62±17 years) as compared to 1041 patients (51% male, 63±17 years) in the same period in 2019 corresponding with a significant relative risk reduction of 0.88 (95% CI 0.81-0.96; P=0.006). Similarly, there was a significant reduction in the incidence of STEMI patients (RR 0.52; P=0.009) whereas the incidence of OHCA (RR 1.23; P=0.29) remained unchanged. Conclusion: During the COVID-19 lockdown, there was a significant decrease in patients with chest pain evaluated by the EMS paralleled by a reduction in STEMIs, while the incidence of OHCA remained similar. While the reason for the decrease in chest pain and STEMI consultations is not entirely clear, more attention should be drawn to the importance of contacting the EMS in case of suspected cardiac symptoms in possible future lockdowns.

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REGIONAL CARDIAC NETWORK: THE EXPERIENCE AT THE EMERGENCY MEDICAL SERVICE 118 IN THE BASILICATA REGION IN ITALY

International Journal of Research -GRANTHAALAYAH ◽

10.29121/granthaalayah.v3.i5.2015.3019 ◽

2015 ◽

Vol 3 (5) ◽

pp. 95-110

Author(s):

Antonietta Zaccaro ◽

Antonio Bonacaro

Keyword(s):

Myocardial Infarction ◽

Emergency Medical Service ◽

Acute Coronary Syndromes ◽

Medical Service ◽

Clinical Practices ◽

Basilicata Region ◽

Emergency Medical ◽

Coronary Syndromes ◽

St Elevation ◽

The Impact

The aim of the regional cardiac networks is to offer to those patients affected by Acute Myocardial Infarction (AMI) the quickest and the most efficient treatment in relation to patients' characteristics and to the place where the event occurs. This article describes the experience developed by the Regional Emergency Medical Service of the Basilicata Region (Italy) in creating such a network. The structure of the network, the epidemiological data along with the different types of pathway used in the management of Non-ST elevation acute coronary syndromes are delineated with the aim to offer an overview of the clinical practices actually in place. A retrospective observational study was conducted in 2012 with the aim to understand the incidence of AMI in its various forms: ST segment elevation myocardial infarction (STEMI) and Non-ST elevation acute coronary syndromes (NSTEACS). The development of the Regional Cardiac Network has been shedding light on AMI and giving patients the chance to receive a customized treatment according to their clinical conditions. Further studies are recommended in order to understand the impact of these practices in terms of reduction of mortality and complications.

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