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Is STEMI care the wave of the future?

by on March 17, 2011

By Marie Nordberg
Associate Editor

Is STEMI Patient Care the Wave of the Future?
A systems-based approach for the care of acute ST-elevation myocardial infarction (STEMI) patients is gaining significant attention across the country, with EMS becoming the new “mega-consumer” of quality STEMI care, says Ivan Rokos, MD, FACEP, assistant clinical professor at the Geffen School of Medicine at UCLA and emergency medicine physician at Olive View-UCLA and Northridge Hospitals in Los Angeles.

“In any region, about 50% of all STEMI heart attack patients treated at a cath lab-capable hospital are brought in by EMS,” says Rokos. “The other 50% of patients self-transport.

“There are three ways for paramedics to identify a STEMI in the field,” he adds. “The first is direct interpretation, where they read the EKG themselves. The second option is for the computer on the EKG machine to read it for them, and that’s what we do here in Los Angeles. If it reads acute MI, that’s the paramedics’ ticket to go to a STEMI receiving center. The third option is for paramedics to transmit the EKG to a hospital, have the hospital interpret it and give the go-ahead to transport to the cath lab.”

One critical issue in Los Angeles is the false-positive rate for cath lab activation, says Rokos. “Paramedics should make sure they have a good quality tracing,” he says. “We’ve had cases where the computer misinterpreted the tremors of a patient with Parkinson’s as an acute MI. If it’s not clear, the paramedics should convey that to the base station.”

So, is STEMI care the wave of the future?

“Yes,” says Rokos, “for two reasons. The American College of Cardiology D2B Alliance’s seventh core strategy is using the prehospital EKG to activate the cath lab. Also, the American Heart Association’s Mission: Lifeline project says that STEMI care is a lifeline of things that need to occur: The patient needs to recognize his symptoms and call 9-1-1; EMS needs to diagnose patients quickly and get them to a STEMI receiving hospital; the ED needs to be ready; and the cath lab needs to be activated early on so they’re ready as well.”
—Marie Nordberg, Associate Editor

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