scholarly journals A service evaluation of transport destination and outcome of patients with post-ROSC STEMI in an English ambulance service

2020 ◽  
Vol 5 (1) ◽  
pp. 32-36
Author(s):  
Anthony Platt
Keyword(s):  
Survival Rates ◽  
Coronary Intervention ◽  
Service Evaluation ◽  
Spontaneous Circulation ◽  
Ambulance Service ◽  
Inclusion Criteria ◽  
Percutaneous Coronary ◽  
St Elevation ◽  
The Uk ◽  
Hospital Cardiac Arrest

Background: In the UK, there are approximately 60,000 cases of out-of-hospital cardiac arrest (OHCA) each year. There is mounting evidence that post-resuscitation care should include early angiography and primary percutaneous coronary intervention (pPCI) in cases of OHCA where a cardiac cause is suspected. Yorkshire Ambulance Service (YAS) staff can transport patients with a return of spontaneous circulation (ROSC) directly to a pPCI unit if their post-ROSC ECG shows evidence of ST elevation myocardial infarction (STEMI). This service evaluation aimed to determine the factors that affect the transport destination, hospital characteristics and 30-day survival rates of post-ROSC patients with presumed cardiac aetiology.Methods: All patient care records (PCRs) previously identified for the AIRWAYS-2 trial between January and July 2017 were reviewed. Patients were eligible for inclusion if they were an adult non-traumatic OHCA, achieved ROSC on scene and were treated and transported by (YAS). Descriptive statistics were used to analyse the data.Results: 478 patients met the inclusion criteria. 361/478 (75.6%) patients had a post-ROSC ECG recorded, with 149/361 (41.3%) documented cases of STEMI and 88/149 (59.1%) referred to a pPCI unit by the attending clinicians. 40/88 (45.5%) of referrals made were accepted by the pPCI units. Patients taken directly to pPCI were most likely to survive to 30 days (25/39, 53.8%), compared to patients taken to an emergency department (ED) at a pPCI-capable hospital (34/126, 27.0%), or an ED at a non-pPCI-capable hospital (50/310, 16.1%).Conclusion: Staff should be encouraged to record a 12-lead ECG on all post-ROSC patients, and make a referral to the regional pPCI-capable centre if there is evidence of a STEMI, or a cardiac cause is likely, since 30-day survival is highest for patients who are taken directly for pPCI. Ambulance services should continue to work with regional pPCI-capable centres to ensure that suitable patients are accepted to maximise potential for survival.

PP11 Relationship between hospital characteristics and survival outcomes in out of hospital cardiac arrest (OHCA) patients treated and transported by yorkshire ambulance service (YAS)

2019 ◽  
Vol 36 (10) ◽  
pp. e6.1-e6
Author(s):  
Anthony Platt
Keyword(s):  
Survival Rates ◽  
Coronary Intervention ◽  
Spontaneous Circulation ◽  
Descriptive Statistics ◽  
Ambulance Service ◽  
Inclusion Criteria ◽  
Percutaneous Coronary ◽  
St Elevation ◽  
Hospital Cardiac Arrest ◽  
Hospital Characteristics

BackgroundThere is mounting evidence that post resuscitation care, should include early angiography and primary percutaneous coronary intervention (PPCI) in OHCA where a cardiac cause is suspected. In Yorkshire, the ambulance service can transport patients with a return of spontaneous circulation (ROSC), directly to a regional PPCI unit, if their ECG shows ST elevation myocardial infarction (STEMI) and the PPCI units accept. The aim of this study was to evaluate transport decisions, hospital characteristics and outcome in the form of 30 day survival rates of post-ROSC patients with presumed cardiac aetiology.MethodsOHCA patient care records (PCRs) between January and July 2017 were reviewed. Patients were eligible for inclusion if they were: an adult non-traumatic OHCA: achieved ROSC on scene, and were transported to hospital. Descriptive statistics were used to analyse the data.Results478 patients met the inclusion criteria. 361/478 (75.6%) patients had an ECG recorded, with 149/361 (41.3%) documented cases of STEMI and 88/149 (59.1%) referred to a PPCI unit. 40/88 (45.5%) of referrals made were accepted by PPCI. Patients taken directly to PPCI were most likely to survive to 30 days (25/39, 53.8%). 34/126 (27.0%) patients survived to 30 days after transport to an emergency department (ED) at a PPCI- capable hospital, and 50/310 (16.1%) survived if taken to ED at a non-PPCI capable hospital.ConclusionWork is required to ensure post-ROSC patients receive a 12 lead ECG, and those with STEMI are referred to PPCI, as survival was greatest in this group. 30 day survival was better for patients taken to ED at a hospital with PPCI facilities, than an ED at a general hospital. Discussion needs to take place between YAS and the relevant hospitals in the region to ensure patients are transported to the appropriate destination.

Percutaneous coronary intervention in non-ST elevation acute coronary syndrome

2018 ◽  
pp. 235-250
Author(s):  
Bashir Alaour ◽  
Michael Mahmoudi ◽  
Nick Curzen
Keyword(s):  
Acute Coronary Syndrome ◽  
Coronary Intervention ◽  
Death Rates ◽  
Coronary Syndrome ◽  
Clinical Syndromes ◽  
Percutaneous Coronary ◽  
St Elevation ◽  
Elevation Acute Coronary Syndrome ◽  
Early Invasive Strategy ◽  
The Uk

Coronary heart disease is the single most common cause of death in the UK and in Europe, although death rates are declining in most European countries. Hospital mortality rates between non-ST elevation acute coronary syndrome and ST-elevation myocardial infarction are compared, with an examination of the pathophysiology, clinical syndromes, and trials of conservative versus early invasive strategy throughout the chapter. Finally, special subgroups are considered, including those with anaemia and diabetes mellitus.

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