Impact of establishing regional collaborative network on reperfusion time and prognosis of patients with ST-segment elevated myocardial infarction admitting to community hospitals without percutaneous coronary intervention capacity / 中华心血管病杂志

<p><b>OBJECTIVE</b>To investigate the impact of establishing regional collaborative network on reperfusion time and prognosis of patients with ST-segment elevated myocardial infarction (STEMI) admitting to community hospitals without percutaneous coronary intervention (PCI) capacity (Non-PCI hospital).</p><p><b>METHODS</b>A regional collaborative network was developed, consisting of a PCI center and over 30 Non-PCI hospitals and connected by a tele-transmitted real-time 12-lead electrocardiogram system. This system enables the cardiologists on duty in PCI center to help the physicians in the Non-PCI hospitals (network hospital) to confirm the diagnosis and choose a reperfusion strategy for STEMI patients. All cardiologists in PCI center and physicians in Non-PCI hospitals were trained to follow the flowchart of reperfusion strategies for STEMI patients to shorten the reperfusion time. The mean time from door of Non-PCI hospital to needle of thrombolysis (D-to-N), the mean time from door of PCI center to balloon (D-to-B) and the mean time from the first medical contact to balloon (FMC-to-B) and the 1-year mortality were compared between the 20 months before and the 20 months after establishment of the regional collaborative network for patients with the first medical contact in three network hospitals.</p><p><b>RESULTS</b>After establishment of the regional collaborative network, the mean D-to-N time was significantly shortened from (71 ± 62) min to (28 ± 9) min (P < 0.05), the rate of D-to-N below 30 min was increased from 11% (2/18) to 74% (26/35); the mean FMC-to-B and the mean D-to-B time were remarkably reduced in both complementary percutaneous coronary intervention and transfer percutaneous coronary intervention patients (all P < 0.05), the 1-year mortality post reperfusion was reduced from 15.1% (8/53) to 7.0% (10/142) (P < 0.05).</p><p><b>CONCLUSION</b>The establishment of regional collaborative network could shorten the perfusion time and reduce the 1-year mortality for STEMI patients presenting to Non-PCI hospitals.</p>

The impacts of the establishment of chest pain center on the door-to-balloon time in patients with ST-elevation myocardial infarction by different transfer ways to hospital / 中国介入心脏病学杂志

Objective This study intends to explore the impacts of the establishment of chest pain center(CPC) on the door-to-balloon(D-to-B) time in patients with ST-elevation myocardial infarction (STEMI) by different transfer ways to hospital. Methods A regular CPC and a regional cooperative network were established based on the pre-hospital transmitted real-time 12-lead electrocardiogram system. The STEMI patients were divided into the following three groups by the different transfer ways to hospital before and after the establishment of chest pain center:self-referral groups (group A1, n=52, and group A2, n=65), EMS (emergency medical service ) groups (group B1, n=31, and group B2, n=92) and transfer PCI groups (group C1, n=23, and group C2, n=552). The mean D-to-B time and the rate of D-to-B below 90 minutes were compared between before and after the establishment of CPC and the reasons of reperfusion delay were analyzed. Results There were no statistical differences of the average D-to-B time [(123±78) min vs.(140±123)min, P > 0.05] and the rate of D-to-B time below 90 min (44.2%vs. 46.2%) between group A1 and group A2. The average D-to-B time was significantly shortened in group B2 [(89±66)min] while compared with that in group B1 [(155±115)min, P<0.05] and the rate of D-to-B time below 90 min was remarkably elevated in group B2 compared with that of group B1 (69.6%vs. 32.3%, P<0.05). The average D-to-B time was significant shorter in group C2 than in group C1 [(77±43)min vs. (337±662)min, P<0.05] and the rate of D-to-B time below 90 min was remarkable higher in group C2 than in group C1 (75.7%vs. 21.7%, P<0.05). The longer D-to-B time in self-referral groups was mainly due to the delay of getting informed consent before PCI when occupied catheterization laboratory was the major cause of reperfusion delay in EMS groups and transfer PCI groups. Conclusions The establishment of CPC may significantly shorten the D-to-B time and increase the rate of D-to-B time below 90 min for these patients admitted by EMS and transferred from non-PCI hospitals. However, the pathway for the self-referral patients should be further modified.

Survey of tele-consultation on Internet for care of myocardial infarction carried out by the chest pain center / 中华急诊医学杂志

Objective To study the efficiency of tele-consultation on Internet with transmitting realtime 12-lead ECG carried out by the Chest Pain Center evaluated by the length of time required for the emergency percutaneous coronary intervention (PCI) in patients with ST segment elevation myocardial infarction (STEMI).Methods A total of 435 STEMI patients treated by emergency PCI were divided into the group A (n =98,admitted in 2010),group B (n =114,admitted in 2011) and group C (n =223,admitted in 2012).Data were collected before (2010) and after establishment of the Chest Pain Center (2011 to 2012) including the length of time elapsed from onset of symptoms to the first medical contact (FMC),the length of time required from FMC to the intra-aortic balloon inflated (FMC-2B) and the length of time required from entering the gate of hospital to the intra-aortic balloon inflated (D-2B).Measure data were described with non-normal median and interquartile intervals.Comparisons were made among groups with rank sum test.Results The median time of D2B of three groups were 107,78 and 59 mins in groups A,B and C,respectively.The differences in D2B among three groups were significant (P =0.000).The time of the D2B was shortened significantly because of the patients transferred to the hospital with a variety of ways (P =0.008).However,the length of D2B time was not significantly changed (P =0.846) when patients came to the hospital all on themselves.The median times from symptom onset to FMC in the group A,group B and group C were 112,62 and 78 mins.and the differences among three groups were not statistically significant (P =0.368).The median times of FMC2B in three groups were 287.0,313.5 and 421.8 mins,respectively,and there were no significant differences (P =0.135).Conclusions The establishment of the Chest Pain Center and Internet of things can effectively shorten the duration of D2B in STEMI patients.However,the reduction of time length from the symptom onset to reperfusion must rely on the coordination between communities and health care system.

Study of the pre-hospital diagnostic reliability of real-time tele-transmission of 12-lead electrocardiogram of patients with acute ST-segment elevated myocardial infarction / 中华急诊医学杂志

Objective To evaluate the pre-hospital diagnostic reliability of real-time tele-transmission of 12-lead electrocardiogram of patients with ST-segment elevated acute myocardial infarction (STEMI).Methods The 12-lead electrocardiogram was simultaneously recorded with real-time tele-transmission system and a conventional electrocardiograph in 40 STEMI cases.The width and amplitude of each wave,the deviated amplitude of ST-segment in the same leads were compared by t-test and rank-sum test.Results There were no statistical differences in the width and amplitude of P wave,QRS wave and t wave as well as the deviated altitude of ST-segment between the two separate electrocardiographs (P ＞0.05).There was a significant positive correlation between the two ECG devices in respect of ST-segment elevated altitude (r =0.912,P =0.000).The differential ability of ST-segment elevation between two separate ECG devices kept highly consistent (Kappa value:0.976).Conclusions Real-time tele-transmission of 12-lead electrocardiogram is reliable for the pre-hospital diagnosis of STEMI.

Analysis of emergency medical rescue system of general hospital during spring festival with snow disaster / 中华急诊医学杂志

Objective To explore the strategy of emergency medical rescue of the massive crowd in general hospital during spring festival with snow disaster. Method The clinical data of 20 966 emergency cases were analyzed retrospectively from 22 Jan,2008 to 6 Feb, 2008 with snow disaster, and concerned about the ratio of different diseases, the character of pre-hospital care and the contrast between emergency medical treatment and routine work. Results The accidence of respiratory disease ( 57.3 % ) was followed by gastrointestinal ( 25.5 % ) and trauma (6.2% )during the emergency medical treatment, and surgical trauma, syncope, coma and convulsion were the most common symptoms, also in some conditions, but empties returning was 30.3% . Similar to the above situation, the extremities (56%)and head injury (24%)were most commonly in the hospital emergency department. The incidence of falling accidents was high( 35.7 % ), and two of them were dead due to trauma on died of being trampled, and on the other was electrothermal burn and falling. Conclusions The general hospital is very important in emergency medical treatment, and it should be ready to tackle the emergency disaster, in order to reduce the loss to minimum.

Analysis of epidemiologic characteristics of trauma in 10 654 patients in Guangzhou / 中华急诊医学杂志

Objective To study the epidemiologic characteristics of trauma in the prehospital first-aid in megapolis. Methods The epidemiologic data of 10 654 traumatic patients,including treated by prehospital treatment and emergency treatment from January 2000 to January 2005,were analyzed.Results The proportion of male was 70.96%,adult patients(21～50 years old)79.23%,suburb 62.86%,downtown 37.14%.The patients whose ISS scores surpassed 16 accounted for 37.98%,which caused by traffic accident was 37.74%,by public order 24.39%,by industrial trauma 21.71%.The trauma in the limbs accounted for 67.51%,cephalic and cervical wounds accounted for 58.64%,multiple wounds 41.77%,thoracic and abdominal wounds 39.41%.Three hundred and sixty one were killed on the spot,which caused by traffic accident were 46.81%,by public order 28.81%,by industrial trauma 14.40%.Forty-two percent point six six patients died of multiple trauma,54.07% died of cephalic and cervical trauma,15.79% died of thoracic and abdominal wounds.Conclusion Suburban area gradually became the frequently-occurred areas of trauma in megapolis. The wounded were mainly young adults and had a tendency of juvenility.The majority of damaging and lethal factors were traffic accident,public order and industrial trauma.Some pertinet measures and professional first-aid models may improve the traumatic first-aid level.

PLASMA LEVELS OF TXB_2, 6-KPGF_(1?), cAMP AND cGMP IN CHRONIC COR PULMONALE / 解放军医学杂志

To investigate the relationship between plasma levels of TXB2, 6-KPGF1?, cAMP and cGMP and the hemodynamics of hypoxemia, 30 patients with chronic cor pulmonale (CCP) were studied. The influence of hypoxemia and isosorbide dinitrate therapy was also observed. The results showed: 1) Plasma TXB2 level was significantly higher and plasma 6- KPGF1? level was significantly lower in CCP patients than in healthy controls. There was a negative correlation between 6 KPGFl? and-Ppa levels and a positive correlation between TXB2, TXB2/ 6 KPGF1? ratio and Ppa levels. 2) High levels of plasma TXB2 and TXB2 / 6-KPGF1? were found in hypoxemia cases when the PaO2 level was less than 6.67 kPa (50 mmHg). 3) Reduced Ppa after isosorbide dinitrate infusion elevated the plasma levels of 6-KPGF1?, cAMP, and the cAMP/cGMP ratio, and reduced those of TXB2 and the TXB2/6-K.PGF1? ratio.