• Olivier Grosgurin, Jérôme Plojoux, Pierre-Frédéric Keller, Marc Niquille, René N'koulou, François Mach, François P Sarasin, and Olivier T Rutschmann.
• Emergency Department, Geneva University Hospitals, Geneva, Switzerland. olivier.grosgurin@hcuge.ch
• Swiss Med Wkly. 2010 Apr 17;140(15-16):228-32.

Question Under StudyTo explore whether early activation of an interventional cardiology team, by prehospital emergency physicians, reduces door-to-balloon time (DTBT) in patients with ST-elevation myocardial infarction (STEMI) diagnosed with prehospital ECG.MethodsDesignbefore-after comparison.Settingemergency department (ED) of an urban teaching hospital with a catheterisation laboratory open continuously.Study Subjectspatients with STEMI diagnosed in the prehospital setting or in the ED within 12 hours of symptoms.Interventiona paging system or "STEMI alarm", activated by prehospital physicians, which simultaneously notified both the catherisation laboratory and cardiology teams before the patient's arrival to the ED.Outcome MeasuresDTBT and the proportion of patients with DTBT <90 minutes.ResultsA total of 196 patients were included; 77 before and 119 after implementation of the "STEMI alarm". Between the two periods, median DTBT decreased from 109 to 76 minutes (p <0.001) and the proportion of patients treated within 90 minutes increased from 36% to 66% (p <0.001). During intervention, the STEMI alarm was activated in 67 patients (56%). In these cases the median DTBT was 50 minutes, with 96% within 90 minutes. The alarm was inappropriately activated in 9 cases (11%).ConclusionsCatheterisation laboratory activation by a prehospital emergency physician markedly reduces DTBT in STEMI patients.

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