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SHR Neuro Cancer Cardio Lipid Metab Microb
Rief, M; Zajic, P; Zoidl, P; Heschl, S; Silbernagel, G; Orlob, S; Prattes, G; Metnitz, P; Prause, G.
Patient disposition following cardiopulmonary resuscitation due to ST-segment elevation myocardial infarction and thrombolysis-case report Which factors influence the choice of transport destination?
NOTFALL RETTUNGSMED. 2019; 22(6): 528-532.
Doi: 10.1007/s10049-019-0571-7
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- Leading authors Med Uni Graz
- Rief Martin
- Co-authors Med Uni Graz
- Heschl Stefan
- Metnitz Philipp
- Orlob Simon
- Prattes Georg
- Prause Gerhard
- Silbernagel Günther
- Zajic Paul
- Zoidl Philipp
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- Abstract:
- A 61-year-old man suffered from cardiac arrest due to myocardial infarction. After 20 min of cardiopulmonary resuscitation (CPR) and thrombolytic therapy prehospitally, return of spontaneous circulation (ROSC) was achieved. The patient was transferred to a nearby community hospital for stabilization efforts instead of a hospital where PCI (percutaneous coronary intervention) could be performed because of the greater distance from the emergency scene. However, the current guidelines of the European Society of Cardiology (ESC) for the treatment of patients with ST-elevation myocardial infarction (STEMI) recommend primary transport to the nearest hospital with the possibility for PCI. The question of whether it makes more sense to transport preclinical STEMI with cardiac arrest, thrombolysis and ROSC to the hospital with PCI possibility that is further away (45 km) or to the nearby hospital (1 km) is explained in the case report. Which allocation strategy is the right one cannot be answered in general. However, other factors such as the possibility of continuous CPR using mechanical resuscitation aids (mCPR device) or the success of thrombolysis can be taken into account in the decision-making in addition to the existing findings and the distance to the nearest hospital with PCI. There is robust evidence that direct transport to a hospital with the capability for PCI is associated with better outcomes. The present case shows difficulties in deciding on the correct referral strategy in clinical practice. Structural measures to improve patient care, such as 24/7 emergency helicopter readiness or the presence of mCPR devices, could help.
- Find related publications in this database (Keywords)
- Acute coronary syndrome
- Cardiopulmonary resuscitation
- Transportation of patients
- Fibrinolysis
- Out-of-hospital cardiac arrest