PARAMEDIC-INITIATED, PREHOSPITAL THROMBOLYSIS USING UROKINASE IN ACUTE CORONARY-OCCLUSION (TICO-2)

Background: Optimal treatment of acute thrombolic coronary occlusion requires prompt diagnosis and early administration of an effective thrombolytic agent. The purpose of this study was to explore the practicality and safety of prehospital thrombolysis in the Sydney ambulance service using a bolus dose of urokinase. Methods: Over an 18-month period, 1577 patients with acute chest pain syndromes were considered by ambulance paramedic officers for prehospital thrombolysis. After clinical evaluation, ECG analysis, and discussion by cellular telephone with a supervising cardiologist or intensivist, 64 patients were accepted for and received urokinase, 2 million U intravenously. Evolving myocardial infarction was subsequently confirmed in 61 (95%). Results: Time interval from onset of symptoms was 83 +/- 40 (SD) minutes, and from ambulance notification to initiation of thrombolysis 41 +/- 9 (SD) minutes. There were no bleeding or other complications of therapy. Conclusions: Prehospital thrombolysis with urokinase is practical and safe, and can result in the thrombolytic agent being administered approximately 1 hour earlier than if definitive treatment is delayed until the patient is assessed in the accident and emergency department of a major hospital.