The AHA Guidelines and Scientific Statements Handbook

The AHA Guidelines and Scientifi c Statements Handbook

Onset of STEMI

A. Out-of-hospital cardiac arrest
Class I
1 All communities should create and maintain a strong
“Chain of Survival” for out-of-hospital cardiac arrest
that includes early access (recognition of the problem
and activation of the EMS system by a bystander), early
cardiopulmonary resuscitation (CPR), early defi brilla-
tion for patients who need it, and early advanced
cardiac life support (ACLS). (Level of Evidence: C)
2 Family members of patients experiencing STEMI
should be advised to take CPR training and familiar-
ize themselves with the use of an automated external
defi brillator (AED). In addition, they should be
referred to a CPR training program that has a social
support component for family members of post-
STEMI patients. (Level of Evidence: B)

Prehospital issues

See Figure 3.4.

A. Emergency medical services systems
Class I
1 All EMS fi rst responders who respond to patients
with chest pain and/or suspected cardiac arrest

should be trained and equipped to provide early

defi brillation. (Level of Evidence: A)

2 All public safety fi rst responders who respond to

patients with chest pain and/or suspected cardiac

arrest should be trained and equipped to provide

early defi brillation with AEDs. (Provision of early

defi brillation with AEDs by nonpublic safety fi rst

responders is a promising new strategy, but further

study is needed to determine its safety and effi cacy.)

(Level of Evidence: B)

3 Dispatchers staffi ng 9-1-1 center emergency

medical calls should have medical training, should

use nationally developed and maintained protocols,

and should have a quality-improvement system in

place to ensure compliance with protocols. (Level of

Evidence: C)

B. Prehospital chest pain evaluation and

treatment

Class I

Prehospital EMS providers should administer 162 to

325 mg of aspirin (chewed) to chest pain patients

suspected of having STEMI unless contraindicated

or already taken by patient. Although some trials

have used enteric-coated aspirin for initial dosing,

more rapid buccal absorption occurs with non-

enteric-coated formulations. (Level of Evidence: C)

Onset of

symptoms

of STEMI

911

EMS

dispatch

5 min after

symptom onset

1 imn Within

8 min

Prehospital fibrinolysis:

EMS-to-needle within 30 min

Patient self-transport: Hospital

door-to-balloon within 90 min

EMS transport:

EMS-to-balloon within 90 min

PCI

capable

Inter-hospital

transfer

Not PCI

capable

Goals†

Patient

Call 911

Call fast

Dispatch

EMS on

scene EMS transport

EMS

triage

plan

Total ischemic time: within 120 min (Golden hour = first 60 minutes)

EMS on-scene

• Encourage 12-lead ECGs


• Consider prehospital fibrinolytic if
  capable and EMS-to-needle within 30 min

Hospital fibrinolysis:

Door-to-needle within 30 min