Door-to-Balloon Times from Freestanding Emergency Departments Meet ST-Segment Elevation Myocardial Infarction Reperfusion Guidelines

• Published in: The Journal of emergency medicine Vol. 46; no. 5; pp. 734 - 740
• Main Authors: Simon, Erin L., DO, Griffin, Peter, BS, Medepalli, Kantha, BS, Griffin, Gregory, Williams, Carolyn J., MS, Hewit, Michael, MS, Lloyd, Thomas S., DO
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.05.2014
• Subjects: Adult; Aged; Angioplasty, Balloon, Coronary - statistics & numerical data; Emergency; Emergency Service, Hospital - statistics & numerical data; Female; freestanding emergency department; Humans; Male; Middle Aged; Myocardial Infarction - therapy; Myocardial Reperfusion - statistics & numerical data; Patient Transfer - statistics & numerical data; Practice Guidelines as Topic; Retrospective Studies; ST-segment elevation myocardial infarction; Time-to-Treatment; freestanding emergency department; ST-segment elevation myocardial infarction
• ISSN: 0736-4679; 2352-5029
• DOI: 10.1016/j.jemermed.2013.08.089

Abstract Background Freestanding emergency departments (FEDs) introduce a challenge to physicians who care for the patient with an ST-segment elevation myocardial infarction (STEMI) because treatment is highly time dependent. FEDs have no percutaneous coronary intervention (PCI) capabilities, which necessitates transfer to a PCI-capable facility or fibrinolysis. Study Objective Our aim was to determine the proportion of STEMI patients who arrived to an FED and were subsequently transferred for PCI and met the door-to-balloon reperfusion guidelines of 90 min. Methods This was a dual-center retrospective cohort review of all patients 18 years and older who were diagnosed with an STEMI and presented to the main hospital−affiliated FEDs. Electronic medical records and emergency medical services documentation were reviewed for all cases since the opening of the FEDs in July 2007 and August 2009, respectively. Key time points were abstracted and statistical evaluation was performed using Fisher's exact test. Results A total of 47 patients met inclusion criteria. Median door-to-transport time was 34 min (interquartile range [IQR] 15 min). Median transport time from the FEDs to the main hospital catheterization laboratory was 21 min (IQR 5 min). Median arrival at the catheterization laboratory-to-balloon time was 25 min (IQR 13 min). Median total door-to-balloon time was 83 min (IQR 10.5 min), with 78.7% meeting the American Heart Association's recommended guidelines of ≤ 90 min. Conclusion STEMI patients initially seen at two FEDs achieved door-to-balloon time goals of < 90 min.