Activation of cardiac catheterization laboratory by emergency physicians reduces door to balloon time for acute myocardial infarction

Patients with typical cardiac chest pain and electrocardiographic evidence of an Acute Myocardial Infarction (AMI), new left bundle branch block or a true posterior Myocardial Infarction are all eligible candidates for timely reperfusion by percutaneous coronary intervention (PCI) (ACC/AHA/SCAI, 2005). According to the American College of Cardiology, American Heart Association and European Society of Cardiology it is recommended that procedure should be performed in a timely manner (balloon inflation or stent placement or both within90 minutes after the first medical contact. Aim: Purpose of review is to evaluate strategies to reduce door to balloon time by activation of cardiac catheterization laboratory by emergency physician and to evaluate the false alarms activation. Methods: A comprehensive computerized search was conducted using Cochrane, Pub Med, Ovid and EBSCO to identify relevant studies. Results: 11 studies were found which examined the relationship between activation of Cardiac catheterization laboratory by Emergency physician to reduce the Door to Balloon time. One (Bradley et al., 2006) was a multivariate analysis surveying 365 hospitals, which showed that having emergency medicine physicians determine whether a myocardial infarction with ST-segment elevation is present and activate the catheterization team without involvement of a cardiologist was strongly associated with a reduced DTBTbut was used in only about 23% of hospitals during weekdays and in 27% of hospitals at night or on weekends (Bradley et al., 2006). Two (Bradley et al., 2006, Bradley et al., 2005) were qualitative studies which showed that the best practices to reduce the DTBT includes assigning the emergency physicians the responsibility for deciding to call in the catheterization team. Eight (Khot et al., 2007; Kurz et al., 2007; Thatcher et al., 2003; Zarich et al., 2004; Jacoby et al., 2005; Singer et al., 2007; Kraft et al., 2007 and Lipton et al., 2006) were pre and post cohort studies conducted in single hospitals, which showed reduced DTBT when Emergency physicians activated the Cardiac Catheterization laboratory without a cardiology consultation. Conclusion: The activation of the cardiac catheterization laboratory by the Emergency physician in cases of ST-elevation AMI shortens the DTBT and does so without using additional resources or costs. This study that has reviewed all relevant literature, supports the development of systems that enable and promote early Emergency Physician activation of cardiac catheter laboratories when patients with ST-elevation MI’s present to the ED.