Pre-Hospital Thombolytics (clot busting drugs for heart attacks in the
ambulance or home) protocols, bennifits, risks, studies supporting doing this
A comment below from Edward-ga is a fairly thorough annotated site listing
discussing the studies supporting (and some not supporting) the use of pre-
hospital thrombolytics, with links to articles on various studies (he’s also
included some about thrombolytic use in ischemic stroke). I have includes links
to some additional articles on those subjects as well.
Essentially, use of thrombolytics to treat acute myocardial infarction is
increasing, and because of the time-sensitive importance of treatment after a
cardiac ischemic event, along with the approval of non-continuous drip IV
thrombolytic drugs, there is a push for EMS protocols to include the
administration of these drugs in a prehospital (ALS) setting. The risks seem to
primarily be that the evaluation for the drugs and the administration of them
may delay transport.
=Protocols=
You also asked about prehospital protocols for administration of thrombolytics.
Different jurisdictions, of course, have different EMS protocols, and at least
some of these around the country include field administration of thrombolytics.
Government bureaucracies work slowly, so it seems likely that the new data
showing the benefits of early administration of thrombolytics will cause more
agencies to include their administration in the field.
The following checklist, part of the University of Texas for administration of
thrombolytics is from the document:
Examples of Prehospital Protocols for Care of Patients with Possible Acute
Myocardial Infarctions
http://www.physio-control.com/documents/thromprotoc.pdf
---Begin quoted material
University of Texas Southwestern Medical Center
Prehospital EMS Chest Pain Checklist
Possible indications for thrombolytics
1. Oriented, able to cooperate
2. Systolic BP difference < 20
BP right arm /
BP left arm /
3. Diastolic BP < 120
4. Systolic BP > 80 and < 180
Possible contraindications for thrombolytics
1. History of stroke or brain surgery
2. Acute trauma of any kind
3. Anticoagulant medications
(coumadin, warfarin, heparin)
4. Known bleeding problems
5. Any GI bleeding in last 12 months
6. Any surgery in last two months
7. Terminal cancer
8. Significant liver or kidney disease
---- End quoted material
The document contains other area protocols, which include the possibility of
administering thrombolytics in the field.
In Tennessee, there is pre-hospital screening for thrombolytics, but it does
not appear that field personnel administer TPA or other drugs:
Adult EMS protocols for the state of Tennessee
http://www.state.tn.us/health/Downloads/g4027217.pdf
Some county protocols do not include prehospital administration of
thrombolytics:
City of Albuquerque / Bernalillo County EMS Protocols
http://www.cabq.gov/fire/protocol2.pdf
Riverside County EMS Policy, Protocol & Procedure Manual
http://www.rivcoems.org/EMSppman/Default.htm
(see section 7200, ALS Cardiac Emergencies)
=Support of Prehospital Thrombolytics for AMI=
The following article suggests that there is a reduction in mortality of 18%
when thrombolytics are administered in the field. It is on MedScape, which
requires registration, though registration is free:
Update on Strategies to Improve Thrombolysis for Acute Myocardial Infarction
from Pharmacotherapy
http://www.medscape.com/viewarticle/409729
in particular this section of it is relevant:
Reducing delays in administering thrombolytics
http://www.medscape.com/viewarticle/409729_3
“Studies of thrombolytic therapy administered before hospital arrival, or in
the field, reported reduction in mortality of approximately 18% (1.7% absolute
reduction) associated with a gain of 61 minutes in time to treatment compared
with conventionally administered thrombolytics.[33] The ACC-AHA guidelines
recommend that prehospital administration of thrombolytics be considered only
when transport to a medical facility would exceed 90 minutes.”
The article goes on to discuss the issues with older thrombolytics, like
streptokinase, in that they require continuous infusion which is difficult to
do in a non-hospital setting.
=Non Support of Prehospital Thrombolytics for AMI=
There are also arguments against the use of thrombolytics, and some continue to
suggest improvements in ECG abilities on ALS transport units.
This article about the use of automatic defibrillators and 12-lead ECGs in the
Field offers a view toward reducing the time from the MI event to the
administration of thrombolytics in the emergency department of the hospital:
Current State of the Art in the Management of Patients with Acute Myocardial
Infarction and Ischemia within the Maryland Emergency Medical Service System
http://www.openseason.com/chestpain/clinicalinformation/maryland/bass.html
=Studies regarding the prehospital use of thrombolytics=
EMS-Compass -- Prehospital Thrombolytics / Fibrinolytics
http://www.mhf.net/emscompass/cardiology/bibliographies/D_thrombolytics.htm
Greenville County EMS Pilot Project Testing Prehospital Thrombolytic Therapy
http://www.scems.com/edassn/newsletter/page4.html
I hope this information is helpful to you in your search. Good luck!
#If you have any other info about this subject , Please add it free.#
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