Paramedic-Delivered Prehospital Thrombolysis Reduces the Time to Reperfusion Therapy in Patients Suffering ST Elevation Myocardial Infarction in Rural and Regional NSW.
Heart, lung & circulation · 2025-11-01 · Registry study
Abstract
BACKGROUND: Regionalised systems of care can improve outcomes for patients suffering ST-elevation myocardial infarction (STEMI). Most reports evaluate primary percutaneous intervention programs in metropolitan centres. We report the outcomes of a prehospital thrombolysis program in rural New South Wales (NSW) with particular focus on the impact of paramedic-delivered thrombolysis on total ischaemic time (TIT). METHOD: Prospective registry study of patients from rural and regional NSW who were diagnosed with STEMI while in the care of NSW Ambulance paramedics. RESULTS: Between 2008 and 2020, paramedics treated 2,710 patients diagnosed with STEMI while in their care, and 1,674 (61.9%) received thrombolysis in the field. TIT for patients treated in the field was shorter (94; interquartile range [IQR] 69-141 minutes) compared to the estimated time for those treated after arrival at hospital (172; IQR 124-250 minutes; p<0.0001). Multivariate analysis identified prehospital thrombolysis as the strongest predictor of reduced TIT. CONCLUSIONS: This program has delivered substantial reductions in TIT for STEMI patients in regional and rural NSW. Similar programs should be considered wherever a significant proportion of the population does not have timely access to percutaneous coronary intervention.
Tags
Antithrombotics & thrombolytics · Paramedics & EMTs · Rural & remote · Thrombolytics · Time intervals