Clinical Update - PPCI Criteria

Dear colleagues,

I hope you are well.

First of all can I thank you for everything you are doing for patients that are being treated and transported to PPCI centres following a STEMI diagnosis. As you are aware ’Time is Myocardium’ and every minute you save has the potential to increase a more favourable outcome to the patient.

I have recently reviewed a selection of missed PPCI’s >150 (min) target of call to balloon times and wanted to share with you some of the themes and findings.

Overwhelmingly there is an increase in significant delay to dispatch with EEAST having encountered significant pressure for C2 dispatch linked to REAP and Surge. There is ongoing systemwide work that is looking to improve this as we enter winter and a national trial being undertaken in with C2 acuity of calls.

One of the consistent themes is our on scene times with patients with a diagnosed STEMI’s, in a number of cases these have been quite elongated with times up to 76 minutes. When I have analysed these extended times I have noticed that in most of the cases several ECG’s where undertaken along with a number of sets of base line observations. This was further increased with all of the STEMI treatment being given on scene prior to departure. One of the causes for delaying on scene is the activation of the PPCI pathway, with some crews sending the ECG to the centre and awaiting acceptance from the PPCI centre before initiating transportation.

Whilst I realise that some cases will have an extended on scene time due to a number of factors, I would advocate that if your first 12 lead ECG is diagnostic, that is sufficient and only one set of observations are required on scene. All interventions can be delivered on route to hospital, particularly if the transport time to PPCI is elongated. The ECG does not need to be sent to the PPCI centre for them to accept the patient, if the patient meets the PPCI pathway as per the checklist it’s an autonomous decision by the clinician.

I have attached the most recent Clinical Update that defines the PPCI referral criteria and would urge you to read it and disseminate with your colleagues.

I meet regularly with PPCI centres in order to improve patient outcome and experience, therefore we happy to take any ideas, suggestions or concerns you have, please feel free to email me carl.smith@eastamb.nhs.uk or alternatively if you have a story you would like to share please let me know. If you do meet resistance getting a patient accepted by PPCI please Datix it and I will take that specific case to the meeting for discussion.   

Please don’t take this as a general moan, it’s not in any way shape or form, I simply want to try and improve this service collectively for our patients.

- Carl Smith (Clinical Lead)

 

Published 14th November 2022