PPCI CORONARY ARTERY REPERFUSION Primary Percutaneous Coronary - - PDF document

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Management of ST elevation myocardial infarction (STEMI)

What is a STEMI? CORONARY ARTERY REPERFUSION

• Primary Percutaneous

Coronary Intervention (PPCI)

• Thrombolysis
• Pre-hospital thrombolysis

(PHT)

• In-hospital thrombolysis

PPCI

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Thrombolysis

Current GWAS Management of STEMI patients

• Convey for PPCI
• If outside of local PPCI

service availability – administer PHT

• If outside of local PPCI

service availability and unable to administer PHT – convey to nearest Emergency Department for In-hospital thrombolysis

• Avon sector – Bristol Heart Institute

24/7

• Gloucestershire sector – Cheltenham

General Hospital Monday-Friday 0830- 1630

• Wiltshire sector

– Great Western Hospital, Swindon Monday-Friday 0830-1630 – RUH, Bath Monday-Thursday 0900-1700, Friday 0900-1230 – Salisbury – no PPCI service

Proposed STEMI management

‘PPCI or PHT only’

• Convey to local PPCI provider when

service is available

• Administer pre-hospital thrombolysis if

local PPCI provider service not available

• Convey to regional PPCI 24/7 provider if

local service not available and unable to administer PHT

Avon sector STEMI patients

• No change to current procedures
• Patients already conveyed to Bristol Heart

Institute 24/7 for PPCI

3 Gloucestershire sector STEMI patients

• If arrival time at Cheltenham General Hospital is between 0830 and 1630, Monday to

Friday, patient will be conveyed for local PPCI

• If outside of local PPCI service availability, patient will be administered pre-hospital

thrombolysis

• If outside of local PPCI service availability and unable to administer PHT, patient will

be conveyed to either Bristol Heart Institute of John Radcliffe, Oxford, which ever is nearest.

Wiltshire sector STEMI patients

• BANES
• PPCI at RUH
• If service not

available – PHT

• If no local PPCI and

unable to administer PHT, convey to Bristol Heart Institute

Wiltshire sector STEMI patients

• Swindon
• PPCI at GWH
• If service not available – PHT
• If no local PPCI and unable to administer PHT, convey to

Bristol Heart Institute or John Radcliffe, Oxford which ever is nearest

Wiltshire sector STEMI patients

• South Wiltshire
• No local PPCI service
• Administer pre-hospital thrombolysis
• If unable to administer PHT, convey to Southampton

4 Implications

• Increased journey time for patients

conveyed to regional 24/7 PPCI centre, particularly given current PPCI service availability

• Resource implication whilst ambulance

conveying patient to and returning from regional PPCI centre – no additional resource funding allocated to GWAS for this service

Benefits

• Improved patient care
• Reduction in subsequent conveyance for

rescue angioplasty

• Step towards SHA plan for all STEMI

patients to receive PPCI

Thank you David Coates GWAS Reperfusion Lead