Time-consuming procedures and prehospital thrombolytic treatment

Objectives: To assess time-consuming procedures in the prehospital stage of acute myocardial infarction patients who had received thrombolytic therapy at the scene, and to evaluate their effect on the clinical outcome. Design: Prospective study. Setting: Mobile intensive care unit staffed by an intern or a hospital-based physician. Participants and Interventions: Thrombolytic therapy with recombinant tissue-type plasminogen activator (total dose of 120 mg/6 hrs) was initiated at the scene in 167 patients. Treatment continued during transportation and thereafter in the cardiac care unit. During hospitalization, radionuclide ventriculograms and coronary angiography were performed in most patients. Measurements and Main Results: Correct diagnosis was confirmed in 165 of 167 patients. Mean time to treatment was 96±42 (SD) mins with no significant difference between patients treated at home (n = 105) or in public places (n = 60). Global duration of treatment was significantly shorter when thrombolytic therapy was given in public as compared with treatment applied at home (50 ± 13 vs. 57 ± 16 mins, respectively, p < .002). Conclusion: If patients and physicians become aware of the potential advantages of prompt initiation of thrombolytic therapy at the scene, critical time may be saved in delivering thrombolysis to the clotted coronary artery.