Uso da terapia fibrinolítica pré-hospitalar para o tratamento do infarto agudo no miocárdio

Abstract

Cardiovascular diseases are one of the main causes of death worldwide, with acute myocardial infarction (AMI) accounting for the highest number of deaths in Brazil and the projection for the year 2020 is that 40% of the deaths will be related to diseases of the circulatory system. In Brazil, cardiovascular diseases (CVD) are among the top 10 causes of death, with a mortality rate of 48.9% in 2007 due to diseases of the circulatory system, and in Ceará this rate was 39,3%. The administration of fibrinolytics for patients with STEMI (AMI with ST-segment elevation) prior to arrival at the hospital has been implemented in several countries, such as France; and from April 2017 in the State of Ceará, through the intervention implemented in SAMU 192 Ceará (CE). The nurse is an indispensable professional in the attention to patients submitted to fibrinolytic therapy after acute myocardial infarction. With the objective of elucidating the available scientific evidence on the use of fibrinolytic for infarcted patients, in the Brazilian prehospital care. The bases used for searching were SCOPUS, CINAHL, PUBMED and VHL. Three strategies were used to cross the databases: i. Infarction AND fibrinolytic AND emergency medical services; ii. Infarction AND thrombolytic AND emergency medical services; iii. Infarction AND first aid AND fibrinolytic. After using the inclusion criteria and adequacy to the objective of the integrative review, ten studies were selected. Of the studies selected 50% were found in CINAHL, 40% in PubMed and 10% in SCOPUS. When at the level of evidence, most (70%) are well-delineated clinical trials without randomization or well-designed cohort and case-control studies. Among the journals, 60% were cardiology and 40% general medicine. The countries of publication are: USA (50%), France (20%), Germany (10%), Australia (10%) and England (10%). When evaluating the methodology of the studies, it can be observed that only two (20%) were not complete. These were divided into three groups according to their objectives: Therapy evaluation (60%), Research on barriers to treatment adherence (10%) and Description of therapy and patients submitted to it (30%). Of the group that evaluated the therapy, there was no consensus, half affirm that there is improvement in the prognosis of the patient and the other half affirm that there was no improvement. The group that studied what impeded implementation found that the main barriers are: training, experience, equipment and organizational factors. It can be concluded that there is still an expressive gap in the bases, since few studies are about, especially those that make long-term analysis.