Implementing prehospital thrombolysis in regional Tasmania A retrospective cohort study
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Abstract
Background: Patients with ST-elevation myocardial infarction (STEMI) in regional Tasmania frequently encounter reperfusion delays. Ambulance Tasmania recently implemented prehospital thrombolysis (PHT) as part of a pharmacoinvasive strategy. This study aimed to describe a cohort of the first patient encounters involving STEMI treated under the new guideline to review the implications of the PHT initiative and inform ongoing implementation.
Methods: This was a descriptive, retrospective cohort study of the first 30 consecutive patient encounters involving PHT for STEMI at Ambulance Tasmania from August 2021 to October 2022.
Results: Despite meeting reperfusion targets in only two cases, the average time of 52 minutes from first medical contact (FMC) to PHT was 24.4 minutes shorter than pre-PHT. When an intensive care paramedic attended first, an additional 13 minutes was saved. There were no significant adverse events. Despite signs of successful PHT for 70% (n=21) of patients, 60% (n=18) were admitted directly to the catheterization lab for angiography and PCI.
Conclusion: This study describes a cohort of patients treated under a new PHT guideline in Tasmania located too far from a percutaneous coronary intervention (PCI) centre to achieve national reperfusion targets for primary PCI, but close enough to make angiography decisions post-PHT challenging. The findings support PHT as a safe process that reduces the FMC to needle interval. Additional research is required to understand better the local PCI practices specific to Tasmania to optimize PHT as part of a broader pharmacoinvasive strategy. Recommendations for ongoing implementation include upgrading ECG transmission capability and extending thrombolysis to all levels of paramedics. The service should engage paramedics to further reduce FMC to needle times and use quality improvement initiatives to improve clinical documentation and pre-alert communication. Finally, adopting the Utstein-style data collection tool would facilitate standardized reporting and help identify areas for ongoing improvement in PHT.
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