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ECGs administered by paramedics can speed treatment for severe heart attacks
Date:7/20/2012

ission of the ECG allows for a real-time conversation between the physician and EMS, decreases false positive test results for STEMI, and improves resource allocation by decreasing activation of the catheterization laboratory when it is not warranted. The emergency room is bypassed in positive cases, and patients are directly transported to the cardiology department or the PPCI laboratory. In cases in which the physician finds the ECG negative for STEMI (PHENST), patients are transported to the nearest emergency room.

The investigators evaluated 380 cases from July 2008 to July 2010. Of 226 patients confirmed with STEMI, 70% received PPCI, 21% received PHL, and 20% underwent coronary angiography without revascularization. The median time from first medical contact to treatment in the PHL treatment group was 32 minutes. In the PPCI group, the median time was 76 minutes. In the PHENST group, 41% were directed to a hospital capable of PPCI and 59% were sent to one of the six other hospitals in the system. They presented more often outside of normal catheterization laboratory hours. 44% were diagnosed with acute coronary syndromes, including seven cases of missed STEMI, and a higher mortality rate.

"The adoption of similar strategies in other urban areas could allow for achievement of guideline times, particularly for PPCI and regardless of the time of day," says Dr. Ducas. "Transfer of patients with suspicious but negative ECG for STEMI (PHENST) to hospitals with comprehensive cardiac care may be warranted, and deserves further consideration."

In a related study, Dr. Ducas and her team audited 703 cases evaluated by EMS. 323 cases were evaluated as negative for STEMI and therefore were not transmitted to the on-call physician. Upon arrival at the nearest emergency room, 52% received a diagnosis of "nonspecific chest pain" and were subsequently discharged; one case of STEMI was missed, and 2 other patients developed STEMI after a
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Contact: Erika Brown-Schumann
e.schumann@elsevier.com
215-239-3704
Elsevier
Source:Eurekalert

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