Clinical Events and Treatment in Prehospital Patients with ST-segment Elevation Myocardial Infarction

Ryan D, Craig AM, Turner L, Verbeek PR.
Prehosp Emerg Care. 2012 Apr;17(2):181-6.

LINK TO ABSTRACT

This very simple study examined the rate of prehospital clinical complications of patients with a confirmed STEMI.

Among those patients who were diagnosed at home and transported to the hospital, 27% of these patients developed a significant adverse clinical event.  The most common events were sinus bradycardia (57 out of 342), hypotension (52 out of 342), or cardiac arrest (13 out of 342).

  • 27% of prehospital STEMI patients will have a serious adverse event while en route to the hospital
    • Sinus Bradycardia 16%
    • Hypotension 15%
    • Cardiac Arrest 6%

Among those patients with a STEMI that are being transferred from one hospital to another, the rate of significant adverse clinical events was much lower at 6.2%.  The most common events were sinus bradycardia (3 out of 145), and hypotension (7 out of 145).  None in this group developed cardiac arrest.  It is unclear why this group would be so different from the home diagnosed patients.   They could have improved with treatment or self selected by presenting as a walk in patient.

Take Home Point

Suspected STEMI patients should have a second medic in the ambulance if at all possible due to the high rate of adverse clinical events.

Dr. Sporer is the EMS Medical Director for Alameda County

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