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Efficacy of Manual Compression versus Closure Devices in Achieving Femoral Artery Haemostasis after Percutaneous Coronary Intervention
303 Effect of Initiating a “Code STEMI” Protocol on Door to Balloon Time in the Management of Acute ST-Elevation Myocardial Infarction J. Amin 1,∗ , K. Blackman 2 , A. Thomson 1 , M. Nicholson 1 , L. Bowman 1 , L. Galligan 1 , P. Roberts-Thomson 1 1 Cardiology Department, Royal Hobart Hospital, Hobart, Aus-
tralia 2 Emergency Department, Royal Hobart Hospital, Hobart, Aus-
tralia Background: Percutaneous coronary intervention (PCI) is the exclusive method of reperfusion in acute ST-segment elevation myocardial infarction (STEMI) in our hospital. A 90 min benchmark for Door to Balloon time has been established. Previous audit of our practice resulted in the introduction of a “Code STEMI” protocol to reduce the time to reperfusion. The aim of this study was to assess the effect on Door to Balloon time. Methods: Two groups of patients were compared. Group A, a historical control group included all STEMI patients who underwent PCI from April to December 2008. Group B included all STEMI patients who underwent PCI from April to December 2009, after the introduction of the “Code STEMI” protocol. The protocol involves mobilisation of the cath lab team with a single call by the senior Emergency Department doctor immediately after specified criteria are met. Results: Group A included 50 patients. 20 patients had a Door to Balloon time < 90 min (40%); 96.5 (85, 132) min [median, (IQR)]. Median time “in hours” 90 min, “after hours” 104 min. Group B included 35 patients. 24 patients had a Door to Balloon time <90 min (68.5%); 87.0 (72, 94) min [median, (IQR)]. Median time “in hours” 80.5 min, “after hours” 89 min. There was an improvement in median time to reperfusion of 9.5 min (P < 0.01), the greatest gain occurring in the “after hours” presentations (15 min). Conclusion: The implementation of a “Code STEMI” protocol in our hospital has significantly improved reperfusion times in the treatment of acute STEMI. We are continuing to refine the process to further minimise the Door to Balloon times. doi:10.1016/j.hlc.2010.06.970 304 Efficacy of Manual Compression versus Closure Devices in Achieving Femoral Artery Haemostasis after Percutaneous Coronary Intervention P. D’Ambrosio 2 , M. Pitney 1,2 , A. Lau 1,2,∗ 1 Eastern Heart Clinic, Prince of Wales Hospital, Sydney, Australia 2 University of New South Wales, Sydney, Australia
Background: Access-site complications are significant concerns in PCI. Closure devices (CD) have simplified
Abstracts
S129
post-procedural groin management, although it remains contentious whether CD actually decrease complications compared with manual compression. Aim: To compare the efficacy of manual compression (MC) by the Compressor clamp with 2 common CD, Angioseal (AS) and Perclose (PC), in achieving femoral artery haemostasis after PCI. Method: In 250 consecutive patients undergoing PCI via femoral access, we compared post-PCI groin outcomes by MC (n = 128), AS (n = 38) or PC (n = 84). Choice of strategy was at the operators’ discretion. We recorded major (vascular occlusion, surgical repair, bleeding requiring transfusion) and minor (arteriovenous fistula, pseudoaneurysm, bruising ≥5 cm) access-site complications. Bruising included superficial ecchymosis (E) and palpable haematoma (H) measured day-1 post-PCI. Results: There were no major complications. Minor complications occurred in 24% of patients and, except for 2 cases of pseudo-aneurysm requiring thrombin injection (MC n = 1, AS n = 1, PC n = 0), consisted entirely of bruising (E or H) ≥5 cm (MC 21%, AS 37%, PC 23%; p = 0.056). Using an industry guideline of ≥2.5 cm, 36% of patients were bruised (MC 30%, AS 58%, PC 36%; p < 0.001), with half (17%) being H (MC 13%, AS 32%, PC 18%; p = 0.001). When present, H were mostly small (2.5–5 cm) but E were mostly large (≥10 cm). Conclusions: PCI via femoral access is safe, but CD did not decrease complications. In our study, AS significantly increased bruising/haematomas compared with MC and PC, whilst MC and PC had similar outcomes. We also showed that assessment of access-site bruising needs to distinguish superficial E from deeper H. doi:10.1016/j.hlc.2010.06.971 305 Emergency Cardiac Catheterisation for Resuscitated Out of Hospital Cardiac Arrest: An Ongoing Challenge But Not Futile M. Dooris Royal Brisbane and Women’s Hospital, Australia Aim: We investigated the characteristics and outcome of patients with resuscitated out of hospital cardiac arrest (CA) referred from Emergency Medicine for emergency cardiac catheterization strategy (ECS). Methods: Our department has an ECS for ST elevation (STE) myocardial infarction and CA. Data was extracted from a prospective database (2008–2010). Descriptive data was collated. Logistic regression (LR) and Cox proportional hazards (CPH) models of survival were created. Credible intervals for CA mortality from Bayesian inference using Gibbs sampling (BUGS) were derived. Results: Twenty-six (26) CA were identified (14% referrals). The descriptive findings were: age: 64 ± 14 years; male: 21 (81%); STE: 5 (19%)-3 revascularised (RV), 2 no significant lesions; shock: 6 (23%); RV: 17 (65%)-percutaneous coronary intervention (PCI) 16, bypass surgery 2; normal coronary arteries (NCA): 5 (19%); balloon pump: 15 (58%);
ABSTRACTS
Heart, Lung and Circulation 2010;19S:S1–S268
tralia 2 Emergency Department, Royal Hobart Hospital, Hobart, Aus-
tralia Background: Percutaneous coronary intervention (PCI) is the exclusive method of reperfusion in acute ST-segment elevation myocardial infarction (STEMI) in our hospital. A 90 min benchmark for Door to Balloon time has been established. Previous audit of our practice resulted in the introduction of a “Code STEMI” protocol to reduce the time to reperfusion. The aim of this study was to assess the effect on Door to Balloon time. Methods: Two groups of patients were compared. Group A, a historical control group included all STEMI patients who underwent PCI from April to December 2008. Group B included all STEMI patients who underwent PCI from April to December 2009, after the introduction of the “Code STEMI” protocol. The protocol involves mobilisation of the cath lab team with a single call by the senior Emergency Department doctor immediately after specified criteria are met. Results: Group A included 50 patients. 20 patients had a Door to Balloon time < 90 min (40%); 96.5 (85, 132) min [median, (IQR)]. Median time “in hours” 90 min, “after hours” 104 min. Group B included 35 patients. 24 patients had a Door to Balloon time <90 min (68.5%); 87.0 (72, 94) min [median, (IQR)]. Median time “in hours” 80.5 min, “after hours” 89 min. There was an improvement in median time to reperfusion of 9.5 min (P < 0.01), the greatest gain occurring in the “after hours” presentations (15 min). Conclusion: The implementation of a “Code STEMI” protocol in our hospital has significantly improved reperfusion times in the treatment of acute STEMI. We are continuing to refine the process to further minimise the Door to Balloon times. doi:10.1016/j.hlc.2010.06.970 304 Efficacy of Manual Compression versus Closure Devices in Achieving Femoral Artery Haemostasis after Percutaneous Coronary Intervention P. D’Ambrosio 2 , M. Pitney 1,2 , A. Lau 1,2,∗ 1 Eastern Heart Clinic, Prince of Wales Hospital, Sydney, Australia 2 University of New South Wales, Sydney, Australia
Background: Access-site complications are significant concerns in PCI. Closure devices (CD) have simplified
Abstracts
S129
post-procedural groin management, although it remains contentious whether CD actually decrease complications compared with manual compression. Aim: To compare the efficacy of manual compression (MC) by the Compressor clamp with 2 common CD, Angioseal (AS) and Perclose (PC), in achieving femoral artery haemostasis after PCI. Method: In 250 consecutive patients undergoing PCI via femoral access, we compared post-PCI groin outcomes by MC (n = 128), AS (n = 38) or PC (n = 84). Choice of strategy was at the operators’ discretion. We recorded major (vascular occlusion, surgical repair, bleeding requiring transfusion) and minor (arteriovenous fistula, pseudoaneurysm, bruising ≥5 cm) access-site complications. Bruising included superficial ecchymosis (E) and palpable haematoma (H) measured day-1 post-PCI. Results: There were no major complications. Minor complications occurred in 24% of patients and, except for 2 cases of pseudo-aneurysm requiring thrombin injection (MC n = 1, AS n = 1, PC n = 0), consisted entirely of bruising (E or H) ≥5 cm (MC 21%, AS 37%, PC 23%; p = 0.056). Using an industry guideline of ≥2.5 cm, 36% of patients were bruised (MC 30%, AS 58%, PC 36%; p < 0.001), with half (17%) being H (MC 13%, AS 32%, PC 18%; p = 0.001). When present, H were mostly small (2.5–5 cm) but E were mostly large (≥10 cm). Conclusions: PCI via femoral access is safe, but CD did not decrease complications. In our study, AS significantly increased bruising/haematomas compared with MC and PC, whilst MC and PC had similar outcomes. We also showed that assessment of access-site bruising needs to distinguish superficial E from deeper H. doi:10.1016/j.hlc.2010.06.971 305 Emergency Cardiac Catheterisation for Resuscitated Out of Hospital Cardiac Arrest: An Ongoing Challenge But Not Futile M. Dooris Royal Brisbane and Women’s Hospital, Australia Aim: We investigated the characteristics and outcome of patients with resuscitated out of hospital cardiac arrest (CA) referred from Emergency Medicine for emergency cardiac catheterization strategy (ECS). Methods: Our department has an ECS for ST elevation (STE) myocardial infarction and CA. Data was extracted from a prospective database (2008–2010). Descriptive data was collated. Logistic regression (LR) and Cox proportional hazards (CPH) models of survival were created. Credible intervals for CA mortality from Bayesian inference using Gibbs sampling (BUGS) were derived. Results: Twenty-six (26) CA were identified (14% referrals). The descriptive findings were: age: 64 ± 14 years; male: 21 (81%); STE: 5 (19%)-3 revascularised (RV), 2 no significant lesions; shock: 6 (23%); RV: 17 (65%)-percutaneous coronary intervention (PCI) 16, bypass surgery 2; normal coronary arteries (NCA): 5 (19%); balloon pump: 15 (58%);
ABSTRACTS
Heart, Lung and Circulation 2010;19S:S1–S268