Prehospital Management of Acute STEMI: Practical Approaches and International Strategies for Early Intervention

258 Pages·2015·3.7 MB·English

by  Alejandro Barbagelata

CARDIOVASCULAR TEAM APPROACH SERIES
PREHOSPITAL MANAGEMENT OF
ACUTE S TEMI
PRACTICAL APPROACHES AND
INTERNATIONAL STRATEGIES
FOR EARLY INTERVENTION
Volume Editors:
Edga r do Es coba r , MD, FACC, FAHA
Aleja ndr o Ba r ba gela t a , MD, FAHA, FSCAI

Prehospital
Management of
Acute STEMI
Practical Approaches and
International Strategies for
Early Intervention
The Cardiovascular Team Approach
A book series focusing on the interprofessional team approach
for the management and prevention of cardiovascular diseases.
Editors-in-Chief:
Joseph S. Alpert, MD, FAHA, FACC, MACP, FESC
Lynne T. Braun, PhD, CNP, FAHA, FAAN
Barbara J. Fletcher, RN, MN, FAHA, FAAN
Gerald Fletcher, MD, FAHA, FACC, FACP
Look for these and other forthcoming series titles from
Cardiotext Publishing.
Volume 1: Heart Failure: Strategies to Improve Outcomes
Ileana L. Piña, MD, MPH, FACC, FAHA, and
Elizabeth A. Madigan, PhD, RN, FAAN, editors
Volume 2: Prehospital Management of Acute STEMI: Practical
Approaches and International Strategies for Early Intervention
Edgardo Escobar, MD, FACC, FAHA, and
Alejandro Barbagelata, MD, FAHA, FSCAI, editors
Volume 3: Acute Coronary Syndrome: Urgent and Follow-up Care
Eileen Handberg, PhD, ARNP, BC, FAHA, FACC, and
R. David Anderson, MD, MS, FACC, FSCAI, editors
Volume 4: Atrial Fibrillation: A Multidisciplinary Approach to
Improving Patient Outcomes
N.A. Mark Estes III MD, FACC, FHRS, FAHA, FESC, and
Albert L. Waldo, MD, PhD (Hon), FACC, FHRS, FAHA, FACCP, editors
Please visit www.cardiotextpublishing.com for more information about this series.
Prehospital
Management of
Acute STEMI
Practical Approaches and
International Strategies for
Early Intervention
The Cardiovascular
Team Approach Series
VOLUME 2
Edgardo Escobar, MD, FACC, FAHA
Alejandro Barbagelata, MD, FAHA, FSCAI
Volume Editors
Joseph S. Alpert, MD, FAHA, FACC, MACP, FESC
Lynne T. Braun, PHD, CNP, FAHA, FAAN
Barbara J. Fletcher, RN, MN, FAHA, FAAN
Gerald Fletcher, MD, FAHA, FACC, FACP
Editors-in-Chief
Minneapolis, Minnesota
© 2015 Joseph S. Alpert, Lynne T. Braun, Barbara J. Fletcher, Gerald Fletcher
Cardiotext Publishing, LLC
3405 W. 44th Street
Minneapolis, Minnesota 55410
USA
www.cardiotextpublishing.com
Any updates to this book may be found at:
cardiotextpublishing.com/prehospital-management-of-acute-stemi
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[email protected].
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This book is intended for educational purposes and to further general scientific and medical
knowledge, research, and understanding of the conditions and associated treatments discussed
herein. This book is not intended to serve as and should not be relied upon as recommending
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Library of Congress Control Number: 2015933408
ISBN: 978-1-935395-66-9
Printed in the United States of America
To my wife Josefina for her patience and to ITMS, Telemedicina
for giving me the inspiration
—Edgardo Escobar
To my beloved wife and 3 beautiful children
—Alejandro Barbagelata

Contents
About the Editors-in-Chief xiii
About the Authors xv
Abbreviations xix
Introduction I ncreasing Importance of Prehospital Care of
ST-Segment Elevation Myocardial Infarction 1
Edgardo Escobar and Alejandro Barbagelata
Part 1:  Program Development for Prehospital STEMI 
Care  Systems:  Focus on the  United States 
Experience
Chapter 1 Delays and Decision Points in Prehospital
STEMI Management Systems: A Framework for
Reducing the Gap Between the Scientific
Guidelines and the Real-World Experience 7
Qiangjun Cai and Alejandro Barbagelata
Introduction 7
Patient Delay—Early Symptom Recognition 8
System Delay—First Medical Contact,
Door-to-Balloon, and Door-in Door-out 10
Prehospital ECG 14
False Activation—The “Collateral Damage” of
Reducing Time to Reperfusion 17
Systems of Care—The AHA Mission: Lifeline®
Program STEMI Networks 20
Cardiac Arrest in STEMI—Time Is Life: Extending
the Chain of Survival 23
  vii
viii Contents
Prehospital Fibrinolysis or Pharmacoinvasive
Therapy in the Real World—Why It Does
Not Work in the United States 25
Conclusion 28
References 28
Chapter 2 The Time Dilemma and Decision Making for
Prehospital Fibrinolysis, Hospital Fibrinolysis,
and/or Transfer to a Percutaneous Coronary
Intervention Center 37
Freij Gobal, Abdul Hakeem, Zubair Ahmed,
and Barry F. Uretsky
Introduction 37
“Time is Muscle” and the “Golden Hour”
for Reperfusion 38
Therapeutic Options with Anticipated Delay
to PPCI of > 90 to 120 Minutes 45
Adjunctive Prehospital Pharmacotherapy 54
Conclusion 61
References 62
Chapter 3 Prehospital ECG Acquisition/Interpretation:
Emerging Technology Applied to STEMI Care 69
Michael J. Pompliano and George L. Adams
Introduction 69
Advancements in Technology 70
ECG Acquisition 71
Interpretation Accuracy 72
Benefits of ECG Telemedicine for Triage and
Mobilization of Resources 76
Future of the Prehospital ECG and Telemedicine 80
Conclusion 82
References 82
Chapter 4 ECG Pitfalls in Early Recognition of STEMI:
Ischemic Versus Nonischemic ST Elevation 87
Henry D. Huang, Waleed T. Kayani, Salman J. Bandeali,
and Yochai Birnbaum
Introduction 87