Question: My question is in regards when a crew has a positive STEMI result on a cardiac ischemia call. I noticed that on these types of calls there has been incidents where patients have been going in lethal dysrhythmias as crews are trying to deliver the patient to the cath lab. Most recently I was at a hospital and as a crew was entering the elevator the patient went into V-Tach and there was a delay to defibrillating because the crew had to attach the defib pads.

I noticed myself when entering the cath lab the first thing the staff does before even accepting the patient and allowing crews to disconnect the cardiac monitor is attach defib pads. Due to the high mortality rates (5%) of STEMI patients transported by EMS and the time it takes to attach the defib pads when the patient enters the lethal rhythm, would it be wise to attach the defib pads on positive STEMI patients during transport(even though they have not gone VSA) to decrease the time to defibrillated the patient if in fact the patient enters the letahal rhythm.

 Great question. This exact issue was discussed recently by the SWORBHP Medical Council based upon communication from EMS services and cath lab staff. The decision to apply defib pads vs monitoring electrodes is an operational/service based decision. Our advice is to apply defib pads if the patient is in a pre-arrest/unstable or arrested condition. Given the 3% cardiac arrest rate we have seen with our current STEMI bypass program, it would not be necessary to apply defib pads for 97% of our transports.

However, once in the cath lab, the incidence of arrhythmias is much higher when occluded arteries are opened and blood flow re-established into ischemic/infarcted myocardium. As such, hospital based cath labs have a lower threshold to apply defib pads to their patients.

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