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Weekly Checks Improve Real-Time Prehospital ECG Transmission in Suspected STEMI

Published online by Cambridge University Press:  30 April 2018

Nicole T. D’Arcy
Affiliation:
Harbor-UCLA Medical Center and Los Angeles Biomedical Institute, Torrance, California USA; David Geffen School of Medicine at UCLA, Los Angeles, California USA University of California San Francisco Department of Emergency Medicine, San Francisco, California USA
Nichole Bosson
Affiliation:
Harbor-UCLA Medical Center and Los Angeles Biomedical Institute, Torrance, California USA; David Geffen School of Medicine at UCLA, Los Angeles, California USA The Los Angeles County Emergency Medical Services Agency, Los Angeles, California USA
Amy H. Kaji
Affiliation:
Harbor-UCLA Medical Center and Los Angeles Biomedical Institute, Torrance, California USA; David Geffen School of Medicine at UCLA, Los Angeles, California USA
Quang T. Bui
Affiliation:
Harbor-UCLA Medical Center and Los Angeles Biomedical Institute, Torrance, California USA; David Geffen School of Medicine at UCLA, Los Angeles, California USA
William J. French
Affiliation:
Harbor-UCLA Medical Center and Los Angeles Biomedical Institute, Torrance, California USA; David Geffen School of Medicine at UCLA, Los Angeles, California USA
Joseph L. Thomas
Affiliation:
Harbor-UCLA Medical Center and Los Angeles Biomedical Institute, Torrance, California USA; David Geffen School of Medicine at UCLA, Los Angeles, California USA
Yvonne Elizarraraz
Affiliation:
Harbor-UCLA Medical Center and Los Angeles Biomedical Institute, Torrance, California USA; David Geffen School of Medicine at UCLA, Los Angeles, California USA
Natalia Gonzalez
Affiliation:
Harbor-UCLA Medical Center and Los Angeles Biomedical Institute, Torrance, California USA; David Geffen School of Medicine at UCLA, Los Angeles, California USA
Jose Garcia
Affiliation:
Harbor-UCLA Medical Center and Los Angeles Biomedical Institute, Torrance, California USA; David Geffen School of Medicine at UCLA, Los Angeles, California USA
James T. Niemann
Affiliation:
Harbor-UCLA Medical Center and Los Angeles Biomedical Institute, Torrance, California USA; David Geffen School of Medicine at UCLA, Los Angeles, California USA
Corresponding
E-mail address:

Abstract

Introduction

Field identification of ST-elevation myocardial infarction (STEMI) and advanced hospital notification decreases first-medical-contact-to-balloon (FMC2B) time. A recent study in this system found that electrocardiogram (ECG) transmission following a STEMI alert was frequently unsuccessful.

Hypothesis

Instituting weekly test ECG transmissions from paramedic units to the hospital would increase successful transmission of ECGs and decrease FMC2B and door-to-balloon (D2B) times.

Methods

This was a natural experiment of consecutive patients with field-identified STEMI transported to a single percutaneous coronary intervention (PCI)-capable hospital in a regional STEMI system before and after implementation of scheduled test ECG transmissions. In November 2014, paramedic units began weekly test transmissions. The mobile intensive care nurse (MICN) confirmed the transmission, or if not received, contacted the paramedic unit and the department’s nurse educator to identify and resolve the problem. Per system-wide protocol, paramedics transmit all ECGs with interpretation of STEMI. Receiving hospitals submit patient data to a single registry as part of ongoing system quality improvement. The frequency of successful ECG transmission and time to intervention (FMC2B and D2B times) in the 18 months following implementation was compared to the 10 months prior. Post-implementation, the time the ECG transmission was received was also collected to determine the transmission gap time (time from ECG acquisition to ECG transmission received) and the advanced notification time (time from ECG transmission received to patient arrival).

Results

There were 388 patients with field ECG interpretations of STEMI, 131 pre-intervention and 257 post-intervention. The frequency of successful transmission post-intervention was 73% compared to 64% prior; risk difference (RD)=9%; 95% CI, 1-18%. In the post-intervention period, the median FMC2B time was 79 minutes (inter-quartile range [IQR]=68-102) versus 86 minutes (IQR=71-108) pre-intervention (P=.3) and the median D2B time was 59 minutes (IQR=44-74) versus 60 minutes (IQR=53-88) pre-intervention (P=.2). The median transmission gap was three minutes (IQR=1-8) and median advanced notification time was 16 minutes (IQR=10-25).

Conclusion

Implementation of weekly test ECG transmissions was associated with improvement in successful real-time transmissions from field to hospital, which provided a median advanced notification time of 16 minutes, but no decrease in FMC2B or D2B times.

D’ArcyNT, BossonN, KajiAH, BuiQT, FrenchWJ, ThomasJL, ElizarrarazY, GonzalezN, GarciaJ, NiemannJT. Weekly Checks Improve Real-Time Prehospital ECG Transmission in Suspected STEMI. Prehosp Disaster Med. 2018;33(3):245249.

Type
Original Research
Copyright
© World Association for Disaster and Emergency Medicine 2018 

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Footnotes

Conflicts of interest: The authors have no conflicts of interest to report. The authors alone are responsible for the content and writing of the paper.

References

1. Mozaffarian, D, Benjamin, EJ, Go, AS, et al. Heart disease and stroke statistics--2015 update: a report from the American Heart Association. Circulation. 2015;131(4):e29-e322.CrossRefGoogle Scholar
2. Global Burden of Disease Study Collaborators. Global, regional, and national incidence, prevalence, and years lived with disability for 301 acute and chronic diseases and injuries in 188 countries, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet. 2015;386(9995):743-800.CrossRefGoogle Scholar
3. Bradley, EH, Nallamothu, BK, Herrin, J, et al. National efforts to improve door-to-balloon time results from the Door-to-Balloon Alliance. J Am Coll Cardiol. 2009;54(25):2423-2429.CrossRefGoogle ScholarPubMed
4. Krumholz, HM, Bradley, EH, Nallamothu, BK, et al. A campaign to improve the timeliness of primary percutaneous coronary intervention: Door-to-Balloon: An Alliance for Quality. JACC Cardiovasc Interv. 2008;1(1):97-104.CrossRefGoogle Scholar
5. Bates, ER, Jacobs, AK. Time to treatment in patients with STEMI. NEJM. 2013;369(10):889-892.CrossRefGoogle ScholarPubMed
6. Menees, DS, Peterson, ED, Wang, Y, et al. Door-to-balloon time and mortality among patients undergoing primary PCI. NEJM. 2013;369(10):901-909.CrossRefGoogle ScholarPubMed
7. Nallamothu, BK, Normand, SL, Wang, Y, et al. Relation between door-to-balloon times and mortality after primary percutaneous coronary intervention over time: a retrospective study. Lancet. 2015;385(9973):1114-1122.CrossRefGoogle ScholarPubMed
8. Nam, J, Caners, K, Bowen, JM, Welsford, M, O’Reilly, D. Systematic review and meta-analysis of the benefits of out-of-hospital 12-lead ECG and advance notification in ST-segment elevation myocardial infarction patients. Ann Emerg Med. 2014;64(2):176-186.CrossRefGoogle ScholarPubMed
9. Adams, G, Abusaid, G, Lee, B, et al. From theory to practice: implementation of prehospital electrocardiogram transmission in ST-elevation myocardial infarction - a multicenter experience. J Invasive Cardiol. 2010;22(11):520-525.Google Scholar
10. Bosson, N, Kaji, AH, Niemann, JT, et al. The utility of prehospital ECG transmission in a large EMS system. Prehosp Emerg Care. 2015;19(4):496-503.CrossRefGoogle Scholar
11. Eckstein, M, Koenig, W, Kaji, A, Tadeo, R. Implementation of specialty centers for patients with ST-segment elevation myocardial infarction. Prehosp Emerg Care. 2009;13(2):215-222.CrossRefGoogle ScholarPubMed
12. Afolabi, BA, Novaro, GM, Pinski, SL, Fromkin, KR, Bush, HS. Use of the prehospital ECG improves door-to-balloon times in ST segment elevation myocardial infarction irrespective of time of day or day of week. Emerg Med J. 2007;24(8):588-591.CrossRefGoogle ScholarPubMed
13. Kawakami, S, Tahara, Y, Noguchi, T, et al. Time to reperfusion in ST-segment elevation myocardial infarction patients with vs. without prehospital mobile telemedicine 12-lead electrocardiogram transmission. Circ J. 2016;80(7):1624-1633.CrossRefGoogle ScholarPubMed
14. Brown, JP, Mahmud, E, Dunford, JV, Ben-Yehuda, O. Effect of prehospital 12-lead electrocardiogram on activation of the cardiac catheterization laboratory and door-to-balloon time in ST-segment elevation acute myocardial infarction. Am J Cardiol. 2008;101(2):158-161.CrossRefGoogle ScholarPubMed
15. Cheskes, S, Turner, L, Foggett, R, et al. Paramedic contact to balloon in less than 90 minutes: a successful strategy for ST-segment elevation myocardial infarction bypass to primary percutaneous coronary intervention in a Canadian emergency medical system. Prehosp Emerg Care. 2011;15(4):490-498.CrossRefGoogle Scholar
16. Dhruva, VN, Abdelhadi, SI, Anis, A, et al. ST-segment analysis using wireless technology in acute myocardial infarction (STAT-MI) trial. J Am Coll Cardiol. 2007;50(6):509-513.CrossRefGoogle ScholarPubMed
17. Diercks, DB, Kontos, MC, Chen, AY, et al. Utilization and impact of prehospital electrocardiograms for patients with acute ST-segment elevation myocardial infarction: data from the NCDR (National Cardiovascular Data Registry) ACTION (Acute Coronary Treatment and Intervention Outcomes Network) Registry. J Am Coll Cardiol. 2009;53(2):161-166.CrossRefGoogle Scholar
18. Kerem, Y, Eastvold, JS, Faragoi, D, Strasburger, D, Motzny, SE, Kulstad, EB. The role of prehospital electrocardiograms in the recognition of ST-segment elevation myocardial infarctions and reperfusion times. J Emerg Med. 2014;46(2):202-207.CrossRefGoogle ScholarPubMed
19. Squire, BT, Tamayo-Sarver, JH, Rashi, P, Koenig, W, Niemann, JT. Effect of prehospital cardiac catheterization lab activation on door-to-balloon time, mortality, and false-positive activation. Prehosp Emerg Care. 2014;18(1):1-8.CrossRefGoogle ScholarPubMed
20. Zanini, R, Aroldi, M, Bonatti, S, et al. Impact of prehospital diagnosis in the management of ST elevation myocardial infarction in the era of primary percutaneous coronary intervention: reduction of treatment delay and mortality. J Cardiovasc Med. 2008;9(6):570-575.CrossRefGoogle ScholarPubMed
21. Sanchez-Ross, M, Oghlakian, G, Maher, J, et al. The STAT-MI (ST-segment analysis using wireless technology in acute myocardial infarction) trial improves outcomes. JACC Cardiovasc Interv. 2011;4(2):222-227.CrossRefGoogle ScholarPubMed
22. Sorensen, JT, Terkelsen, CJ, Norgaard, BL, et al. Urban and rural implementation of prehospital diagnosis and direct referral for primary percutaneous coronary intervention in patients with acute ST-elevation myocardial infarction. Eur Heart J. 2011;32(4):430-436.CrossRefGoogle Scholar
23. Ting, HH, Krumholz, HM, Bradley, EH, et al. Implementation and integration of prehospital ECGs into systems of care for acute coronary syndrome: a scientific statement from the American Heart Association Interdisciplinary Council on Quality of Care and Outcomes Research, Emergency Cardiovascular Care Committee, Council on Cardiovascular Nursing, and Council on Clinical Cardiology. Circulation. 2008;118(10):1066-1079.CrossRefGoogle Scholar
24. Kruth, P, Zeymer, U, Gitt, A, et al. Influence of presentation at the weekend on treatment and outcome in ST-elevation myocardial infarction in hospitals with catheterization laboratories. Clin Res Cardiol. 2008;97(10):742-747.CrossRefGoogle ScholarPubMed
25. First Responder Network Authority. https://firstnet.gov/. Accessed April 21, 2017.Google Scholar
26. Fakhri, Y, Sejersten, M, Schoos, MM, et al. Algorithm for the automatic computation of the modified Anderson-Wilkins acuteness score of ischemia from the prehospital ECG in ST-segment elevation myocardial infarction. J Electrocardiol. 2017;50(1):97-101.CrossRefGoogle ScholarPubMed

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