As part of a yearly evaluation of the care provided to ST-Elevation Myo-cardial Infarction (STEMI) patients in the region of Neuss in Germany, some aspects of MobiMed were evaluated. MobiMed was used in all ambulances in the region during the majority of 2008, and thereby empowered the regional “ACS-Netzwerk” focused around Lukas Krankenhaus in Neuss. The results show that ambulance STEMI-patients being handled through MobiMed have a lower death risk than those being handled the “traditional” way.
The region of Neuss near Düsseldorf in the western part of Germany has around 450.000 inhabitants. There is one hospital with PCI facilities, Lukas Krankenhaus, and 4 other local hospitals. The region is served by 14 ambulances and some “emergency cars” stationed at various places in the region. The region has a good infrastructure with large motorways making it easy to quickly transport patients to the Lukas Krankenhaus. The incidence rate of STEMI-patients is around 250 a year. In 2008 about 66% of these were taken to Lukas by ambulance, i.e. 150 patients. This was an improvement from 2007 where 58% arrived by ambulance.
During 2008 a MobiMed system was in place and run as part of the local “ACS-Netzwerk”. All ambulances and some emergency cars were equipped with MobiMed 300 units, and the hospitals with MobiMed CWS clients. A protocol was implemented where the ambulance crew should contact Lukas Krankenhaus on all suspected STEMI-patients. Based on the transmitted information (12-lead ECG, vital trends, demographics etc.) decisions were made in dialogue with hospital personnel whether to bring the patient immediately to the PCI-lab or not. Based on the decision the hospital personnel and the PCI-lab were able to prepare for the arrival well in advance.
MobiMed went live in the beginning of 2008 and has been in fully routine operation for about 9 months during the year. During 2008 57% of the Ambulance STEMI-patients where handled in the “traditional” way, i.e. without MobiMed, and consequently MobiMed was used in 43% of the cases. An interesting finding was that MobiMed seemed to be used more frequently with the most seriously ill patients. A lot of statistics around the “ACS-Netzwerk” have been brought forward by Professor Michael Haude and his colleagues. Most interesting in relation to MobiMed was that the 30-day mortality in the MobiMed group, after multivariate adjustment, was 7.5% lower than in the “traditional” ambulance group, 5.8 respectively 13.2. This indicates that if MobiMed was applied in all ambulance STEMI cases a significant reduction in deaths, and most likely an improved medical outcome for the rest, would be the result. In numbers it could mean more than 10 patients a year. The improvement observed by using MobiMed was largely due to a 14 minutes reduced door-to-balloon time.
Reference: Professor Michael Haude, Lukas Krankenhaus, Neuss, Germany
Link: German News article