In an emergency: at home or in the hospital.

Abstract

Treating patients who have myocardial infarctions with intravenous clot-busting drugs at home or in an ambulance significantly reduces the time to treatment and increases the numbers of heart attacks that are stopped in progress. However, patients whose hearts stop in the hospital may find themselves waiting precious minutes while a person skilled in defibrillation is found to restart their heart, said an expert at the American Heart Association Scientific Sessions. In a session on emergency care at the 72nd Scientific Sessions of the American Heart Association in Atlanta, physicians discussed the difficulties and successes in providing treatment for sudden death and myocardial infarction quickly. For example, Evert Lamfers, MD, a physician with the Canisius-Wilhelmina Hospital in Nijmegen, the Netherlands, compared 227 patients treated with antithrombolytics before they reached the hospital with 269 patients who were treated with such drugs while in the hospital. “We looked for the aborted myocardial infarction,” said Dr Lamfers. “If you can abort a bank robbery, you can abort a myocardial infarction as well.” He said that the myocardial infarction was aborted in 4.5% of patients treated while in the hospital and in 12% of those who received prehospital treatment. “Furthermore, we found that those with an aborted myocardial infarction had good mortality—zero at 12 months.” According to Dr Lamfers, “Using prehospital treatment in our own region means we can gain 63 minutes in treatment of the myocardial infarction and treat about 28% …