European Resuscitation Council Guidelines for Resuscitation 2010 ...

1360 H.-R. Arntz et al. / Resuscitation 81 (2010) 1353–1363
• Requiring the catheterization laboratory to be ready within
20 min
• Having an attending cardiologists always at the hospital
• Providing real-time data feedback
• Fostering senior management commitment
• Encouraging a team-based approach
If PPCI cannot be accomplished within an adequate timeframe,
independent of the need for emergent transfer, then immediate
fibrinolysis should be considered unless there is a contraindication.
For those patients with a contraindication to fibrinolysis, PCI should
still be pursued despite the delay, rather than not providing reperfusion
therapy at all. For those STEMI patients presenting in shock,
primary PCI (or coronary artery bypass surgery) is the preferred
reperfusion treatment. Fibrinolysis should only be considered if
there is a substantial delay to PCI.
Triage and inter-facility transfer for primary PCI
The risk of death, reinfarction or stroke is reduced if patients
with STEMI are transferred promptly from community hospitals to
tertiary care facilities for PPCI [82,94,95]. It is less clear whether
immediate fibrinolytic therapy (in- or out-of-hospital) or transfer
for PPCI is superior for younger patients presenting with anterior
infarction and within a short duration of