Cardiology and ambulance care work together for the best care
Recently the Ambulance Cardiology symposium Zwolle (AmbuCareSZ) has taken place. Care for patients with an acute coronary syndrome (myocardial infarction) was the main topic.
For many years there is an intensive cooperation between the department of cardiology of the Isala hospital and the ambulance services. This cooperation has led to improvement of the treatment for patients with a myocardial infarction (acute coronary syndrome). Even though, the aim is still to further improve the treatment. Therefore, several research projects have been setup. During the symposium three investigators have presented their research project.
Direct transfer to a PCI centre
Blood sampling in the ambulance
Sonja Postma, project coordinator at Diagram has investigated the triage (judgment of urgency request for help) and the treatment of patients with a myocardial infarction prior to arrival at PCI centre. Furthermore, she has investigated which characteristics of the electrocardiogram improve the risk assessment of patients with a myocardial infarction. She has concluded that direct transfer to a PCI centre leads to better outcome compared to referral via a non-PCI Centre. She also concluded that living at large distance from a PCI centre does not lead to worse outcome. Moreover, it is very important to differentiate between high and low risk patients.
Rudolf Tolsma, verpleegkundig specialist acute care at RAV IJsselland, investigated the HEART-score. With this score the risk of patients suspicious for a myocardial infarction can be assessed. To investigate the enforceability of the HEART-score, the FAMOUS triage project has been developed. In this project blood sampling is performed in the ambulance in patients who are suspicious for a myocardial infarction. Consequently, in the early phase damage to the heart can be established. In the near future, blood tests can be examined in the ambulance.
Rudolf Tolsma has come to the following conclusions:
- – The HEART score is a valid triage tool for ACS patients
- in the ambulance
- – The judgment by different practitioners can be improved,
- however not one patient in the ambulance was judged
- as ‘low risk’ and in the hospital as ‘high risk
Prevention of important complication
Arnoud Van ’t Hof, cardiologist, has given a presentation about the ATLANTIC trial. In this trial they investigated worldwide the effect of the administration of a new platelet inhibitor, Ticagrelor. This platelet inhibitor was administered in the ambulance or in the hospital to patients with a myocardial infarction. They demonstrated that administration of Ticagrelor in the ambulance does not lead to coronary reperfusion before the PCI procedure. However, they have shown that it prevents an important complication (stent thrombosis). Another important finding is that administration of morphine delays the effect of the antiplatelet inhibitor.
