Early Cardiologist Input via LIFENET ECG Transmission and Pre-Hospital Thrombolysis Achieves Improved Lysis Times for STEMI in a Rural Setting

Background: Rural compared to metropolitan STEMI patients have a higher mortality. Western NSW LHD implemented the State-wide Cardiac Reperfusion Strategy for pre-hospital thrombolysis (PHT) in 2014. Cardiologists confirm ECGs meet STEMI-criteria and paramedics then administer thrombolysis. LIFENET ECG transmission is also available within all non-base hospitals throughout the LHD. We hypothesised that PHT and use of LIFENET would achieve shorter first-contact-to-needle (FCTN) times than in-hospital thrombolysis (IHT). Methods: We retrospectively analysed data on all STEMI patients who underwent thrombolysis within the Western NSW LHD in 2015. Results: 104 patients were thrombolysed for STEMI, with 65 successfully reperfusing. First medical contact was with paramedics in 46% of cases and with ED in 54%. Paramedics administered thrombolysis in 28% of cases and ED in 72%. Overall, mean FCTN time was 55+/-32 min (Table 1). The mean FCTN time for PHT was significantly less than for IHT (44+/-26 min versus 60+/-33 min; p=0.02). There was a non-significant trend towards shorter FCTN times for patients presenting to small rural hospitals whose diagnostic ECG was sent via LIFENET involving early cardiologist input as compared to routine care (55+/-30 min versus 58+/-38; p>0.05).Tabled 1FCTN time0-30min30-60min60-90min>90minPHT(%)275977IHT(%)19411921 Open table in a new tab Conclusion: PHT has achieved shorter FCTN times than IHT within the LHD. Expansion of the LIFENET system with early cardiologist input has scope to further improve FCTN and reduce mortality for rural STEMI patients.