At 18:54 11/03/2009, you wrote:
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>Julian Bradley wrote:
>
> > On a slightly different tack one could also argue that these days out of
> > hospital thrombolysis prevents the single most helpful intervention in
> > those with an MI which is angioplasty.
>
>There is a timescale attached to this, isn't there?
>
> >
> > Let's hope that thrombolysis schemes will be replaced with the least
> > possible delay.
>
>My current best 999 call to hospital door is about 2hrs. Likely more. I
>guess this limits the achievable somewhat, unless we move to
>pre-hospital stenting.
>
>Peter
Maybe you are in an area where air ambulances really would be
justified. Two hours delay is "frightening" in the management of
many emergencies well beyond MI, including accidents, obstetric and
paediatric emergencies. You must have a very stoic community!
:-)
Anyway I'm not an expert and haven't done a full literature
review.... but one point of view is that:
If pre-hospital thrombolysis can be given within 2 hours of the onset
of symptoms (NOT 2 hours from placement of call to services), and
there is delay of more than ?60 ?120m in transfer to PCT it may be a
reasonable strategy.
The easiest online sources I found were:
http://pmj.bmj.com/cgi/content/full/84/988/73
http://heart.bmj.com/cgi/content/abstract/95/5/362
These suggest an more ongoing debate than I was aware of - but
overall it looks as though that debate is really because of the
shortage of 24 hour local cath labs and ambulances, particularly in
the UK, rather than a serious debate about what you'd want if you
could have either treatment rapidly.
Julian
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