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    Prehospital thrombolysis for STEMI where PPCI delays are unavoidable

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    Author
    Lashwood, David
    Keyword
    Emergency Medical Services
    Pre-hospital Care
    Myocardial Infarction
    Thrombolysis
    Primary Percutaneous Coronary Intervention (PPCI)
    Journal title
    Journal of Paramedic Practice
    
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    URI
    http://hdl.handle.net/20.500.12417/1057
    DOI
    10.12968/jpar.2020.12.9.361
    Abstract
    Primary percutaneous coronary intervention (PPCI) is the gold standard for treating patients experiencing ST-elevation acute myocardial infarction (STEMI). More than 30 000 patients experience cardiac arrest out of a hospital setting in the UK every year and may be some distance from a PPCI facility. Aims: To analyse and consider if a better outcome could be achieved for patients if PPCI was an adjunct to thrombolytic therapy, where delays of ≥60 minutes are inevitable or unavoidable. Methods: The current review examined a range of articles, research materials and databases. Results: Some studies suggested the use of prehospital thrombolysis while others compared the effectiveness of drug-eluting stents. While the ‘gold standard’ for the treatment of patients experiencing a myocardial infarction is still PPCI, several factors can delay patients from receiving this treatment at an appropriate facility within the recommended time frame. Conclusion: Patients may not be able to access PPCI within 60, 90 or 120 minutes for reasons including increasing urbanisation, population growth and NHS hospital funding cuts. If the PPCI unit is some distance away, ambulance crews could start thrombolysis treatment and transmit clinical findings to a specialist cardiologist in the PPCI facility, or stop at a local hospital that could provide thrombolysis. Abstract published with permission.
    ae974a485f413a2113503eed53cd6c53
    10.12968/jpar.2020.12.9.361
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