Prehospital management of patients with suspected acute coronary syndrome
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Intensivmedizin und Notfallmedizin
Originalien Med Klin Intensivmed Notfmed https://doi.org/10.1007/s00063-020-00739-3 Received: 29 May 2020 Revised: 5 August 2020 Accepted: 2 September 2020 © The Author(s) 2020 Redaktion M. Buerke, Siegen
V.-S. Eckle1 · S. Lehmann2 · B. Drexler2 1
Medizinische Klinik mit Schwerpunkt Infektiologie und Pneumologie, Charité—Universitätsmedizin Berlin, Berlin, Germany 2 Klinik für Anästhesiologie und Intensivmedizin, Universitätsklinikum Tübingen, Tübingen, Germany
Prehospital management of patients with suspected acute coronary syndrome Real world experience reflecting current guidelines
Introduction Atherosclerotic cardiovascular diseases are the leading cause of premature death in Europe with acute myocardial infarction being the second most common cause of death in Germany [13, 17]. One important measure for improving survival from an acute myocardial infarction is to reduce time delay from first medical contact to interventional coronary reperfusion therapy [8, 10]. Thus, prehospital electrocardiogram (ECG) recording by the emergency medical service after first medical contact in patients presenting with angina may facilitate prehospital triage management, enable an appropriate choice of destination hospital with cardiac catheterization laboratory and therefore reduce treatment delays [6, 7, 12]. Prehospital ECG is associated with lower mortality rates in patients presenting with acute myocardial infarction with ST-elevation (STEMI) or non-STEMI acute coronary syndrome (NSTEMI ACS) [14, 15]. International guidelines recognise prehospital ECG and recommend to obtain a 12-lead ECG as soon as possible after first medical contact in ACS patients [8, 10, 16]. In the present study, we investigated the impact of ST-elevations on time from first medical contact to arrival at the destination hospital, defined as time in prehospital care. Furthermore, we evaluated the handover location of STEMI
and NSTEMI patients at the destination hospital.
Methods The retrospective study was approved by the University Hospital Tübingen ethics committee (approval reference number 401/2018BO1). The study region consisted of 225,000 inhabitants (Tübingen County, Germany). An emergency care service database (Deutsches Rotes Kreuz, Kreisverband Tübingen, Germany) of a mixed urban and rural area was retrospectively analysed from January 2014 to December 2016. Mainly, one local hospital with primary percutaneous coronary intervention facility (University Hospital Tübingen, Germany) served the study
region. Local emergency care service cars were equipped with 12-lead ECG (Corpuls 3, GS Elektromedizinische Geräte G. Stemple GmbH, Kaufering, Germany). All patients with the diagnosis of acute myocardial infarction with ST-elevation (STEMI) or non-STEMI acute coronary syndrome (NSTEMI ACS) were identified from emergency physician protocols (NADOK, Mindeststandard MIND 3.0/3.1 BW, DATAPEC GmbH, Pliezhausen, Germany) and included for further analysis. Exclusion criteria were missing data, no patient transportation
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