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Notifying cardiac catherization labs may
ensure more positive outcomes for
STEMI patients transported by
EMS teams

Pre-activating cardiac catherization labs benefits EMS STEMI patients on arrival

by John R. Fischer , Staff Reporter
Notifying a cardiac catherization lab prior to EMS arrivals could mean a difference in outcome for patients with ST–elevation myocardial infarction (STEMI), says a new study.

Researchers at Duke University found higher chances of survival among patients transported by emergency medical service teams who contacted and pre-activated labs prior to their arrival, a task that often is hindered by confusion as to where this responsibility lies.

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“Many times it is unclear who needs to pre-activate the cath lab,” lead study author Jay S. Shavadia, MD, a cardiologist and researcher from Duke University Medical Center and the Duke Clinical Research Institute, told HCB News. “Is it the EMS, the receiving cardiologist, the interventional cardiologist?

Low rates of pre-activation further risks of disability and death among STEMI patients and are a predicament in the U.S. where cardiac catherization labs are notified at least ten minutes prior to arrival only 41 percent of the time.

Notifying labs beforehand increases the potential for EMS-transported STEMI patients to bypass typical protocols for entering the emergency department first, allowing them to go directly to the cardiac catherization lab. This, in the process, saves critical minutes, with the amount of time afforded to pre-activating a cath lab making a significant difference in patient outcomes, according to the findings.

Shavadia and his colleagues came to these conclusions through their analysis of data on 27,840 pre-hospital identified STEMI patients from within the ACTION Registry, now known as the Chest Pain – MI Registry. Patients were transported to 744 primary percutaneous coronary intervention (PCI)-capable hospitals with cath labs, where they were treated between January 2015 and March 2017.

Median door-to-device time, defined as the time between when a patient arrives and when they are implanted with a balloon and stent to open a cardiac blockage, decreased by 12 minutes. In addition, a higher proportion of patients came into contact with EMS personnel and underwent balloon and stent implantation in less than 90 minutes at once compared to those in hospitals with no cath lab pre-activation.

Findings also revealed a lower likelihood of reperfusion delay for patients presenting during both work and off-hours associated with efficient pre-activation, as well as lower, risk-adjusted, in-hospital mortality, compared to hospitals with lower notification times.

Shavadia says the application of such findings could assist in offsetting the impact of challenges that prevent EMS personnel from activating labs in advance.

“A STEMI diagnosis needs to be confirmed by a cardiologist after speaking with EMS on the field and review of the ECG – this is often a challenge,” he said.

The findings are available in JACC: Cardiovascular Interventions.

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