[Prehospital ECG reduces the delay of thrombolysis in acute myocardial infarction]. / Prehospitalt EKG kan fremskynde trombolytisk behandling ved akutt hjerteinfarkt.

BACKGROUND: Thrombolytic treatment substantially reduces mortality and morbidity in acute myocardial infarction. This survival benefit rapidly declines when thrombolysis is delayed. In our department this delay has previously been measured to be 40 (10-360) minutes. It is important to reduce this time loss. MATERIAL AND METHODS: From two ambulances, 168 patients ECGs were recorded and transmitted to the coronary care unit (CCU) where they were interpreted by a cardiologist or an internist. Patients with an ECG diagnostic of acute myocardial infarction were taken directly to the CCU by-passing the emergency room. In the CCU the nurses were ready to start thrombolytic treatment once consent was given. RESULTS: All 168 ECGs were of excellent quality. 16 of the ECGs transmitted were diagnostic of an acute myocardial infarction. In 15 patients the diagnosis of acute myocardial infarction could be verified on arrival. These were thrombolized at median 15 (8-32) minutes after their arrival at the hospital entrance. INTERPRETATION: Pre-hospital recording and interpreting of ECGs can markedly reduce the time delay between the arrival at the hospital and the starting of thrombolysis in patients with ECGs diagnostic of acute myocardial infarction.

Utstein registration used as a tool in organisational development.

OBJECTIVE: To evaluate the results of out-of-hospital CPR in a county after seven independent local EMS organisations were merged into one, and to evaluate the use of Utstein registration as a tool in the reorganisation process. MATERIALS AND METHODS: All out-of-hospital cardiac arrests in Ostfold county in which the EMS system was responded to in 1997 were registered according to the Utstein template. The results were reported back to the EMS personnel and presented to the media. RESULTS: Of 163 cardiac arrests of cardiac origin where CPR was attempted, 59% received bystander CPR. 13% were discharged from hospital alive (9.1/100 000 inhabitants), 32% of those with VF/VT. At discharge 18 of 22 patients functioned normally with cerebral performance category 1 and Overall performance category 1. The media had previously been very critical of the decision to centralise the emergency services. There was large media coverage when the results were presented, and criticism virtually disappeared. The registration and presentation appeared to create a feeling of unity among the EMS personnel. CONCLUSIONS: The Utstein registration functioned well as a tool both internally and externally in an EMS reorganisation process.