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      A physician‐staffed ground emergency medical service does not significantly shorten door‐to‐balloon time in patients with STEMI: an observational study in a single emergency center in Japan

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          Abstract

          Aim

          Current guidelines recommend a door‐to‐balloon time (DTBT) of <90 min for reperfusion treatment of patients with ST‐segment elevation myocardial infarction (STEMI). A physician‐staffed ground emergency medical service (GEMS) using a rapid response car (RRC) system was implemented at our hospital in April 2015. The medical team, including a physician and nurse, is dispatched to assess the patient and expedite the start of treatment by emergency physicians and cardiologists after arrival at the hospital. The study aimed to determine whether the RRC system shortened the DTBT.

          Methods

          This retrospective observational study was carried out in a tertiary emergency center in Japan. Those STEMI patients with primary percutaneous intervention between January 2016 and December 2018 were evaluated. The DTBTs of patients transported by the RRC system, the emergency medical service (EMS), and transferred from other hospitals after STEMI diagnosis (TRANS group) were compared.

          Results

          A total of 121 patients were included, 33 in the RCC, 20 in the EMS, and 68 in the TRANS groups. The median DTBT was 51 min (interquartile range [IQR], 43–67) in the RRC, 61 min (IQR, 52–85) in the EMS, and 59 min (IQR, 48–72) in the TRANS groups ( P = 0.13). The DTBT was not significantly shorter in the RRC than in the other groups.

          Conclusion

          An RRC physician‐staffed GEMS did not significantly shorten the DTBT of patients with STEMI compared with other transport systems.

          Abstract

          A physician‐staffed ground emergency medical service did not significantly shorten door‐to‐balloon time in treating patients with ST‐segment elevation myocardial infarction.

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          Most cited references10

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          Impact of treatment delay on mortality in ST-segment elevation myocardial infarction (STEMI) patients presenting with and without haemodynamic instability: results from the German prospective, multicentre FITT-STEMI trial

          Karl Scholz, Sebastian Maier, Lars Maier … (2018)
          Abstract Aims The aim of this study was to investigate the effect of contact-to-balloon time on mortality in ST-segment elevation myocardial infarction (STEMI) patients with and without haemodynamic instability. Methods and results Using data from the prospective, multicentre Feedback Intervention and Treatment Times in ST-Elevation Myocardial Infarction (FITT-STEMI) trial, we assessed the prognostic relevance of first medical contact-to-balloon time in n = 12 675 STEMI patients who used emergency medical service transportation and were treated with primary percutaneous coronary intervention (PCI). Patients were stratified by cardiogenic shock (CS) and out-of-hospital cardiac arrest (OHCA). For patients treated within 60 to 180 min from the first medical contact, we found a nearly linear relationship between contact-to-balloon times and mortality in all four STEMI groups. In CS patients with no OHCA, every 10-min treatment delay resulted in 3.31 additional deaths in 100 PCI-treated patients. This treatment delay-related increase in mortality was significantly higher as compared to the two groups of OHCA patients with shock (2.09) and without shock (1.34), as well as to haemodynamically stable patients (0.34, P < 0.0001). Conclusions In patients with CS, the time elapsing from the first medical contact to primary PCI is a strong predictor of an adverse outcome. This patient group benefitted most from immediate PCI treatment, hence special efforts to shorten contact-to-balloon time should be applied in particular to these high-risk STEMI patients. Clinical Trial Registration NCT00794001.
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            Prognostic Implications of Door‐to‐Balloon Time and Onset‐to‐Door Time on Mortality in Patients With ST ‐Segment–Elevation Myocardial Infarction Treated With Primary Percutaneous Coronary Intervention

            Jonghanne Park, Ki Hong Choi, Joo Myung Lee … (2019)
            Background In patients with ST‐segment–elevation myocardial infarction, timely reperfusion therapy with door‐to‐balloon (D2B) time 90 minutes (adjusted hazard ratio, 0.30; 95% CI, 0.19–0.42; P<0.001). Every reduction of D2B time by 30 minutes showed continuous reduction of 1‐year mortality (90 to 60 minutes: absolute risk reduction, 2.4%; number needed to treat, 41.9; 60 to 30 minutes: absolute risk reduction, 2.0%; number needed to treat, 49.2). Conclusions Shortening D2B time was significantly associated with survival benefit, and the survival benefit of shortening D2B time was consistently observed, even <60 to 90 minutes.
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              Association of onset to balloon and door to balloon time with long term clinical outcome in patients with ST elevation acute myocardial infarction having primary percutaneous coronary intervention: observational study

              H Shiomi, Y Nakagawa, T Morimoto … (2012)
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                Author and article information

                Contributors
                Yuki Yoshioka:
                ORCID: https://orcid.org/0000-0003-4898-999X
                mut0211@gmail.com
                Journal
                Journal ID (nlm-ta): Acute Med Surg
                Journal ID (iso-abbrev): Acute Med Surg
                Journal ID (doi): 10.1002/(ISSN)2052-8817
                Journal ID (publisher-id): AMS2
                Title: Acute Medicine & Surgery
                Publisher: John Wiley and Sons Inc. (Hoboken )
                ISSN (Electronic): 2052-8817
                Publication date (Electronic): 15 July 2020
                Publication date Collection: Jan-Dec 2020
                Volume: 7
                Issue: 1 ( doiID: 10.1002/ams2.v7.1 )
                Electronic Location Identifier: e542
                Affiliations
                [ 1 ] Department of Emergency and Critical Care Medicine Tokushima Red Cross Hospital Komatsushima City Japan
                [ 2 ] Department of Cardiology Tokushima Red Cross Hospital Komatsushima City Japan
                Author notes
                [*] [* ] Corresponding: Yuki Yoshioka MD, Department of Emergency and Critical Care Medicine, Tokushima Red Cross Hospital, 103, Irinoguchi, Komatsushima-cho, Komatsushima City, Tokushima 773-8502, Japan. E-mail: mut0211@ 123456gmail.com

                Author information
                https://orcid.org/0000-0003-4898-999X
                Article
                Publisher ID: AMS2542
                DOI: 10.1002/ams2.542
                PMC ID: 7362674
                SO-VID: 96948264-c7d3-47ef-b5d6-74dc019114f9
                Copyright © © 2020 The Authors. Acute Medicine & Surgery published by John Wiley & Sons Australia, Ltd on behalf of Japanese Association for Acute Medicine
                License:

                This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc-nd/4.0/ License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.

                History
                Date received : 24 April 2020
                Date revision received : 09 June 2020
                Date accepted : 12 June 2020
                Page count
                Figures: 1, Tables: 2, Pages: 6, Words: 3852
                Categories
                Subject: Original Article
                Subject: Original Articles
                Custom metadata
                source-schema-version-number 2.0
                cover-date January/December 2020
                details-of-publishers-convertor Converter:WILEY_ML3GV2_TO_JATSPMC version:5.8.5 mode:remove_FC converted:15.07.2020

                Keywords: doctor car,door‐to‐balloon time (dtbt),physician‐staffed ground emergency medical service (gems),rapid response car,stemi
                Data availability:
                Keywords: doctor car, door‐to‐balloon time (dtbt), physician‐staffed ground emergency medical service (gems), rapid response car, stemi

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