The AHA Scientific Statement Implementation and Integration of Prehospital ECGs Into Systems of Care for Acute Coronary SyndromeÂ was published online ahead of print on August 13, 2008.
- Prehospital electrocardiograms (ECGs) in patients with ST-elevation myocardial infarction (STEMI) are associated with a reduction in door-to-needle time of 10 minutes, and a reduction of 10-20 minutes in door-to-balloon time.
- Emergency medical service (EMS) systems serving over 90% of the 200 largest cities in the United States have 12-lead ECG equipment available in their ambulance systems.
- Trained paramedics can identify STEMI with high sensitivity (71-97%), specificity (91-100%), and with good agreement between paramedics and emergency department physicians.
- At least two studies using wireless transmission of ECG have demonstrated a reduction in time to reperfusion. Systems for prehospital wireless transmission are commercially available from Medtronic (Minneapolis, MN), Welch Allyn (Beaverton, OR), Zoll Medical (Chelmsford, MA), and Phillips Healthcare (Andover, MA).
- Appropriate training and ongoing quality assurance for EMS providers and medical control physicians is a key requirement for an effective prehospital ECG-based STEMI care system.
- EMS providers should acquire prehospital ECGs as early as possible during initial scene evaluation.
- Scene time should be minimized when STEMI is diagnosed, and the destination hospital should be notified in advance.
- EMS providers or the emergency physician should activate the catheterization laboratory while the patient is en route to the hospital.
- Hospitals providing percutaneous coronary intervention (PCI) need to organize reliable wireless networks and technologies, have protocols in place for advanced preparation to receive and evaluate the patient with STEMI, and streamline emergency department evaluation or bypass emergency department evaluation altogether.
- Communities need to develop prehospital triage so that the EMS can bypass non-PCI hospitals when a patient is diagnosed with STEMI.
TheHeart.org’s heartwire interviewed the study’s lead author, Dr. Henry Ting of the Mayo Clinic, in an article published on August 13, 2008. Some of his comments were interesting.
“We’ve coordinated the emergency department, the cath lab, and the cardiology group and have done well with reducing door-to-balloon times, but we’ve not truly engaged the prehospital phase of care. This is critically important.”
“For the past 10 years, this equipment has been available to many paramedics, but what is happening is that when they acquire the ECG it’s not really utilized […] the patient is placed in a critical-care room and receives another ECG. Where’s the value in that?”
Where is the value in that?