European Resuscitation Council Guidelines for Resuscitation ... - CPR

18 de 0ctubre de 2010 www.elsuapdetodos.com1360 H.-R. Arntz et al. / Resuscitation 81 (2010) 1353–1363• Requiring the catheterization laboratory to be ready within20 min• Having an attending cardiologists always at the hospital• Providing real-time data feedback• Fostering senior management commitment• Encouraging a team-based approachIf PPCI cannot be accomplished within an adequate timeframe,independent of the need for emergent transfer, then immediatefibrinolysis should be considered unless there is a contraindication.For those patients with a contraindication to fibrinolysis, PCI shouldstill be pursued despite the delay, rather than not providing reperfusiontherapy at all. For those STEMI patients presenting in shock,primary PCI (or coronary artery bypass surgery) is the preferredreperfusion treatment. Fibrinolysis should only be considered ifthere is a substantial delay to PCI.Triage and inter-facility transfer for primary PCIThe risk of death, reinfarction or stroke is reduced if patientswith STEMI are transferred promptly from community hospitals totertiary care facilities for PPCI [82,94,95]. It is less clear whetherimmediate fibrinolytic therapy (in- or out-of-hospital) or transferfor PPCI is superior for younger patients presenting with anteriorinfarction and within a short duration of