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QJM 2004 97(10):655-661; doi:10.1093/qjmed/hch111
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QJM vol. 97 no. 10 © Association of Physicians 2004; all rights reserved.

Reducing call-to-needle times: the critical role of pre-hospital thrombolysis

J.A.L. Smith1, K.P. Jennings1, E.A. Anderson1, P. Green2 and G.S. Hillis1

1Department of Cardiology, Aberdeen Royal Infirmary and 2Kemnay Medical Group/Scottish Council for Postgraduate Medical and Dental Education, UK

Received 31 March 2004 and in revised form 17 June 2004

Background: Current guidelines recommend that patients with acute myocardial infarction should receive thrombolysis within 60 min of seeking professional help.

Aim: To compare current rates of pre-hospital thrombolysis in Grampian with historical data, and assess the effect of pre-hospital thrombolysis on the proportion of patients achieving ‘call-to-needle’ times within national guidelines.

Design: Prospective audit.

Methods: Data were collected on all patients (n = 535) admitted to the coronary care unit and thrombolysed, either in hospital or in the community from July 2000 to June 2002, using standardized forms.

Results: One hundred and thirty-three patients (25%) received pre-hospital thrombolysis and 402 (75%) received in-hospital thrombolysis. This compares with a 19% (195/1046) pre-hospital thrombolysis rate in the mid-1990s (p = 0.005). Median ‘call-to-needle’ times were 45 min for pre-hospital thrombolysis and 105 min for patients who received in-hospital thrombolysis (p < 0.001). Only 24% (96/396) of patients receiving in-hospital thrombolysis were treated within the recommended guideline, vs. 79% (88/111) of pre-hospital thrombolysis patients (p < 0.001).

Discussion: Pre-hospital thrombolysis rates in Grampian are increasing. Administration of thrombolysis in the community greatly increases the proportion of patients achieving a ‘call-to-needle’ time of 60 min, with a median time saving of ~1 h.

Address correspondence to Dr G. Hillis, Cardiac Research Department, Aberdeen Royal Infirmary, Aberdeen, AB25 2ZN. e-mail: g.hillis{at}abdn.ac.uk


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