3 = 1: cooperative provision of PCI treatment in a rural region

Abstract

Background: In prehospital emergency medicine, fast and structured action is required: optimal infrastructure and supra-regional coordination are essential. In a cooperation between three hospitals with rotating percutaneous coronary intervention (PCI) shifts and three emergency medical services (EMS) organisations in a rural region, the Lower Austrian “STEMI Network Eastern Region” has been ensuring 24/7 PCI availability for more than 750,000 people since 2007. Uniform therapy algorithms and good communication assure guideline-conformant treatment. Timely reflection on treatment data is of the utmost importance due to this special constellation. Methods: In 2012, a web-based registry was set up to record the prehospital care of acute coronary syndrome (ACS) patients within the network. This data analysis includes STEMI (ST-elevation myocardial infarction) patients between February 2012 and April 2015, admitted to one of the three PCI centres (Eisenstadt, Mödling or Wiener Neustadt). Relevant periods of time were analysed: patient delay, EMS delay, system delay, STEMI diagnosis, transport time, time to reperfusion (thrombolysis or PCI). Additionally, patient status on site and during transport, as well as complications, were evaluated. Two case reports illustrate the interaction even in complex situations. Results: A total of 416 STEMI patients were included during the observation period. The mean age of patients was 63.8 ± 13.2 years (29–95), and 73.8% were male. Almost 90% received reperfusion therapy: 83% primary PCI (PPCI) and 6.5% thrombolysis. In total, 31.2% of missions took place at nighttime, which also affected the treatment delay. Five patients (1.2%) died before or during PPCI. Hospital mortality was 2.8% (N = 11). Discussion: The prehospital care of STEMI patients within the network met the requirements of the European Society of Cardiology guidelines. The web-based register is a suitable tool serving as a database for continuous quality management. Conclusion: The presented data demonstrate a high level of prehospital care, despite the rather complex network structure.