PPCI CORONARY ARTERY REPERFUSION Primary Percutaneous Coronary - PDF document

What is a STEMI? Management of ST elevation myocardial infarction (STEMI) PPCI CORONARY ARTERY REPERFUSION • Primary Percutaneous Coronary Intervention (PPCI) • Thrombolysis - Pre-hospital thrombolysis (PHT) - In-hospital thrombolysis 1

Current GWAS Management of Thrombolysis STEMI patients • Convey for PPCI • Avon sector – Bristol Heart Institute 24/7 • If outside of local PPCI • Gloucestershire sector – Cheltenham General Hospital Monday-Friday 0830- service availability – 1630 administer PHT • Wiltshire sector • If outside of local PPCI – Great Western Hospital, Swindon Monday-Friday 0830-1630 service availability and – RUH, Bath Monday-Thursday unable to administer PHT 0900-1700, Friday 0900-1230 – Salisbury – no PPCI service – convey to nearest Emergency Department for In-hospital thrombolysis Proposed STEMI management Avon sector STEMI patients ‘PPCI or PHT only’ • No change to current procedures • Convey to local PPCI provider when • Patients already conveyed to Bristol Heart service is available Institute 24/7 for PPCI • 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 2

Gloucestershire sector STEMI patients Wiltshire sector STEMI patients • BANES • PPCI at RUH • If service not available – PHT • If no local PPCI and unable to administer PHT, convey to • If arrival time at Cheltenham General Hospital is between 0830 and 1630, Monday to Friday, patient will be conveyed for local PPCI Bristol Heart Institute • 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 Wiltshire sector STEMI patients • Swindon • South Wiltshire • PPCI at GWH • No local PPCI service • If service not available – PHT • Administer pre-hospital thrombolysis • If no local PPCI and unable to administer PHT, convey to Bristol Heart Institute or John Radcliffe, Oxford which • If unable to administer PHT, convey to Southampton ever is nearest 3

Implications Benefits • Increased journey time for patients • Improved patient care conveyed to regional 24/7 PPCI centre, • Reduction in subsequent conveyance for particularly given current PPCI service rescue angioplasty availability • Step towards SHA plan for all STEMI • Resource implication whilst ambulance patients to receive PPCI conveying patient to and returning from regional PPCI centre – no additional resource funding allocated to GWAS for this service Thank you David Coates GWAS Reperfusion Lead 4