Prehospital thrombolysis

Will pave the way for accelerated management of acute myocardial infarction

The national service framework for coronary heart disease has set a series of challenging targets for medical practitioners across a range of disciplines, aimed at reducing this leading cause of mortality in the United Kingdom. In many areas, notably the delivery of secondary prevention after acute myocardial infarction, these challenges have largely been met. The benefits of prompt thrombolysis for acute myocardial infarction are well recognised,1 and early patency of the relevant artery is now the holy grail of management. Difficulties remain, however, in delivering effective and timely treatment, with a target “call to needle” time of less than 60 minutes stated by the national service framework.2 Reorganisation of in-hospital care (devolving the administration of thrombolysis to emergency departments, appointment of specialised chest pain triage nurses, and use of bolus lytic agents) has brought about great advances in the past three years, and 76% of eligible patients now receive thrombolysis within 30 minutes of arrival in hospital.3 Problems surrounding transfer to hospital remain, …