STEMI: 10 Things You Need to Know to Save Lives

5. Clear a path to reperfusion therapy

Prehospital 12-lead ECGs have been shown to reduce the time to reperfusion in hospitals. A STEMI alert may be activated based on a transmitted ECG to the emergency department or a paramedic’s interpretation of the 12-lead and calling in a STEMI alert.

At PCI centers, the cath lab must be prepared, staff called in during off-hours, and elective procedures delayed. When these tasks are done prior to arrival, EMS may bypass the ED with STEMI patients and go directly to the cath lab for faster coronary reperfusion. You will need to notify the hospital early so they can marshal the resources they’ll need.

6. ASA ASAP

After time to reperfusion, the next most important interval is time to aspirin. Aspirin inhibits platelet aggregation that would make the clot larger, thus slowing down damage to the heart muscle. Chewing and ingesting 160-320 mg of aspirin is a pre-arrival instruction in many 911 call centers and BLS protocols.

7.  Easy on the O's

One long-standing treatment that has fallen out of favor is routine oxygen administration. High flow oxygen has been shown to cause vasoconstriction, which increases infarct size. Only administer oxygen to ACS patients who are short of breath and only enough to titrate the pulse-ox reading to 94%.

8. Take a load off the left heart (or prime the pump on the right)

When the heart muscle is dying from an infarct, easing its workload may slow infarct progression. Nitroglycerine, available in sublingual tabs, spray, paste, or an intravenous infusion, accomplishes this through vasodilation, which decreases preload and afterload.

A damaged right ventricle can reduce preload to the left ventricle, which could be made worse if nitroglycerine is administered. When a right-side STEMI is identified, the treatment of choice is a fluid bolus to increase contractility. Use nitroglycerine with caution, if at all, with a known right-side infarction.

9. Not all ST elevation is an MI

Other causes of ST elevation include pericarditis, benign early repolarization, bundle branch blocks, hypertrophy, and pacemakers. Be aware of these subtle differences in ECG interpretation to prevent an inappropriate STEMI activation. While a certain degree of over triage to the cath lab is acceptable, false activations drain hospital resources that could be utilized elsewhere.

10. Excellent STEMI care requires a systems approach

An EMS performance benchmark paper states that for every fifteen STEMI patients who receive a prehospital ECG, aspirin, and transport to a PCI facility, one stroke, second MI, or death is prevented². Successful STEMI systems of care require cooperation from EMS, multiple hospitals, and departments within hospitals. 

To provide the best care to the STEMI patient, EMS services need to get the right patients to the right facilities, and a clear path to reperfusion must be in place at those facilities. Early activation of the receiving hospital is critical. Hospitals must mobilize resources. Spending seconds to notify the hospital early saves muscle, morbidity and lives.