North of Scotland Planning Group is a collaboration between NHS Grampian, NHS Highland, NHS Orkney, NHS Shetland, NHS Tayside and NHS Western Isles

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Primary and secondary percutaneous coronary intervention and thrombolysis for acute coronary syndrome

Introduction There are a number of challenges to delivering PCI and thrombolysis in the North of Scotland, particularly around the rurality and distances from specialist cardiac centres and PCI labs. These issues have been debated locally and within the North of Scotland cardiac sub-group. In an effort to find a process to resolve some of the issues a small group of clinicians and managers met in Inverness in December 2013. In considering these issues the group felt it was important for future work to be considered in reference to what is currently achievable locally and regionally, within existing budgets and in the context of the recently revised SIGN guidance for Acute Coronary Syndromes. SIGN guidance Te following SIGN guidance is particularly relevant to all areas in the North of Scotland and should be central to future debate and local protocols.

• Patients with suspected acute coronary syndrome should be assessed

immediately by an appropriate healthcare professional and a 12 lead

electrocardiogram should be performed.

• Patients with an ST elevation acute coronary syndrome should be treated

immediately with primary percutaneous coronary intervention.

o Primary percutaneous coronary intervention should be delivered by the

centre with the least travel time for the individual patient.

• When primary percutaneous coronary intervention cannot be provided within 120

minutes of ECG diagnosis, patients with an ST elevation acute coronary

syndrome should receive immediate thrombolytic therapy.

• Consideration should be given to pre-hospital and admission thrombolysis, and to

the emergency transfer of patients to interventional centres for primary

percutaneous coronary intervention.

• Patients presenting with ST elevation acute coronary syndrome within six hours

of symptom onset, who fail to reperfuse following thrombolysis, should be

considered for rescue percutaneous coronary intervention.

NORTH OF SCOTLAND PLANNING GROUP

Meeting: North of Scotland Planning

Group - Cardiac Service Sub Group

Date: 25th March 2014

Item: 05/14 iii

North of Scotland Planning Group is a collaboration between NHS Grampian, NHS Highland, NHS Orkney, NHS Shetland, NHS Tayside and NHS Western Isles

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Moving forward The SIGN guidance recommends that all areas develop local protocols for pre- hospital and hospital care. In the North of Scotland there is an urgent need to agree these in the context of what if achievable within the regional resource and the exiting budgets. The cardiac sub-group is asked to convene a small representative group (health and ambulance service) to articulate these protocols and present them to future cardiac sub-group for debate and approval.

Keith Farrer, Programme Manager, North of Scotland Planning Group March 2014