Inappropriate cath lab activation ‘low’
MedWire News: The rate of inappropriate cardiac catheterization laboratory (CCL) activation by emergency personnel is relatively low, finds a study.
Combined with the high rate of coronary intervention, this finding suggests that systematic CCL activation by emergency personnel on a broad scale is feasible, report Lee Garvey (Carolinas Medical Center, Charlotte, North Carolina, USA) and co-authors in Circulation.
They examined CCL activation at 14 primary angioplasty hospitals to determine the rate of inappropriate activation between December 2008 and December 2009.
The method of ST segment-elevation myocardial infarction (STEMI) diagnosis was based primarily on emergency physician or paramedic interpretation of the electrocardiogram (ECG) at all hospitals.
Among 3973 activations, of which 29% were by emergency medical technicians and 71% by emergency physicians, appropriate CCL activations occurred for 3377 (85%) patients. Of these, 2598 (76.9%) patients underwent primary percutaneous coronary intervention (PCI).
Inappropriate activations occurred in 596 (15%) patients. These were due to ECG emergency medical service reinterpretations, which accounted for 427 (72%) patients, and the fact that the patient was not an appropriate CCL candidate due to age greater than 90, treatment refusal, or active bleeding, which accounted for 169 (28%) patients. Other reasons for the patient being an inappropriate CCL candidate included known terminal illness, severe comorbid conditions, and/or a do not resuscitate order.
The rate of cancellation due to ECG reinterpretation was more often due to an emergency medical technician than an emergency physician, at 6.0% versus 4.6%.
"EMS systems and hospital providers may be able to reduce the incidence of inappropriate system activation by continued improvement in regard to ECG diagnosis and by including CCL candidacy as a consideration," conclude the authors.
By Piriya Mahendra