A report on pre-hospital thrombolysis in regional Tasmania a retrospective chart review

Activity: Supervision/Examination/MentoringInternal HDR Supervision

Description

Introduction: ST elevation myocardial infarction (STEMI) patients in rural Tasmania frequently encounter reperfusion delays. Recent clinical trial data advocates using prehospital thrombolysis (PHT) as an alternative to delayed percutaneous coronary intervention (PCI) in these patients.
Aim: To evaluate Ambulance Tasmania’s newly implemented PHT clinical practice guideline (CPG) by examining the demographics, processes, and outcomes of a cohort of patients treated under a new management guideline.
Methods: The study design is a retrospective chart review. Of the 204 Code STEMI patients identified through the study period, we studied 30 patients who received thrombolysis treatment under the CPG. We used descriptive analysis to describe the cohort and highlight key performance indicators for PHT management.
Results: The average time from first medical contact to thrombolysis was 51.6 minutes (SD=12.9 min). An average of 24.8 minutes of ischaemic time was saved per patient treated under the guideline. When an intensive care paramedic (ICP) was first on scene, time to thrombolysis improved by an average of 15.9 minutes. Despite this, compliance with national reperfusion targets remained low (n=2, 7%). Rates of rescue PCI were found to be high (n=23, 77%). The incidence of adverse events was minimal, with no patients experiencing prehospital bleeding. All patients treated with PHT under the CPG survived to hospital discharge.
Conclusions: The implementation of Ambulance Tasmania’s PHT CPG appears safe and has improved reperfusion metrics for rural STEMI patients. Further familiarisation and development of the CPG will continue to improve these metrics towards conformance with national guidelines.
PeriodMar 2022Oct 2022
ExamineeLouis Jenkins
Examination held at
Degree of RecognitionInternational

Keywords

  • STEMI
  • paramedicine
  • USTEIN
  • performance indicators