Pre-hospital synthesized 12-lead ECG ischemia monitoring with trans-telephonic transmission in acute coronary syndromes

Drew, Barbara J.; Dempsey, Elise; Joo, Tae H.; Sommargren, Claire E.; Glancy, James; Benedict, Kent; Krucoff, Mitchell W.

doi:10.1016/j.jelectrocard.2004.08.060

Cited by 32 publications

(12 citation statements)

References 5 publications

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“…The concept of the derived ECG is not new and has been reported my several investigators [11][12][13][14][15][16][17] . Now that recent guidelines for STEMI 18 and NSTEMI 19 care have called for frequent serial ECGs to be acquired, the utilization of the derived ECG technology may now become more advantageous and clinically useful.…”

Section: Discussionmentioning

confidence: 99%

Detection of acute myocardial ischemic injury by gender using a novel cardiac electrical biomarker

Schreck

Fishberg

2015

The American Journal of Emergency Medicine

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Section: Discussionmentioning

confidence: 99%

Detection of acute myocardial ischemic injury by gender using a novel cardiac electrical biomarker

Schreck

Fishberg

2015

The American Journal of Emergency Medicine

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“…There are also ongoing clinical trials in other parts of the United States evaluating the effectiveness of prehospital ECGs to decrease first medical contact to balloon/drug times. [93][94][95] The Reperfusion of Acute Myocardial Infarction in North Carolina Emergency Departments (RACE) Investigators implemented a statewide approach to improve timeliness of reperfusion therapy for patients with STEMI. 83 The use of prehospital ECGs was high, and prehospital ECGs were acquired in 61% and 43% of patients with STEMI transported by EMS to PCI hospitals and non-PCI hospitals, respectively.…”

Section: How Have Prehospital Ecgs Been Incorporated Into Existing Symentioning

confidence: 99%

Implementation and Integration of Prehospital ECGs Into Systems of Care for Acute Coronary Syndrome

Ting¹,

Krumholz²,

Bradley³

et al. 2008

Circulation

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221

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Clinical case: A 58-year-old woman called 9-1-1 with acute onset of chest pain that had persisted for 30 minutes. She had a history of hypertension, hyperlipidemia, and type 2 diabetes mellitus but no previous history of myocardial infarction or heart failure. Her medications included aspirin, atorvastatin, lisinopril, and metoprolol. Paramedics were dispatched, and a prehospital ECG demonstrated 3-to 4-mm ST-segment elevation in leads I, aVL, and V 2 through V 6 (Figure 1). Her examination revealed a regular pulse of 90 bpm, a blood pressure of 100/60 mm Hg, clear lungs, and normal heart sounds with no murmurs. Paramedics interpreted the prehospital ECG and activated the catheterization laboratory en route to the hospital. On hospital arrival, the patient was transported directly to the catheterization laboratory. Coronary angiography demonstrated an occluded proximal left anterior descending artery, which was successfully treated with balloon angioplasty and a stent. The pertinent time intervals were as follows: paramedic dispatch to balloon time, 56 minutes; paramedic arrival at the scene to balloon time, 46 minutes; hospital door to balloon time, 23 minutes. Her biomarkers revealed a peak troponin T of 2.42 ng/mL and a peak creatine kinase muscle-brain isoenzyme of 26.8 ng/mL. An echocardiogram demonstrated normal left ventricular ejection fraction of 55%, with mild anterior hypokinesis, and the patient was discharged on hospital day 3. Current Guidelines for Prehospital ECGs Among Patients With ST-Segment-Elevation Myocardial InfarctionAmerican Heart Association national guidelines, 1-3 as well as other consensus and scientific statements, 4 -11 recommend that emergency medical services (EMS) acquire and use prehospital ECGs to evaluate patients with suspected acute coronary syndrome. Despite these recommendations, prehospital ECGs are used in fewer than 10% of patients with ST-segment-elevation myocardial infarction (STEMI), 12,13 and this rate has not substantially changed since the mid1990s. Furthermore, even when a prehospital ECG is acquired, the information is often not effectively translated into action and coordinated with hospital systems of care to decrease delays in reperfusion therapy. 13 The purpose of this article is to summarize evidence concerning the benefits of using prehospital ECGs, review barriers and challenges to routine use, and recommend approaches to enhance their effectiveness for improving quality of care for patients with acute coronary syndromes.The American Heart Association makes every effort to avoid any actual or potential conflicts of interest that may arise as a result of an outside relationship or a personal, professional, or business interest of a member of the writing panel. Specifically, all members of the writing group are required to complete and submit a Disclosure Questionnaire showing all such relationships that might be perceived as real or potential conflicts of interest.

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“…However, the lack of purposeful outcomes research is a barrier to having indisputable evidence that continuous ST-segment monitoring enhances the care of cardiac patients in critical care. Investigators in the ongoing ST SMART trial 26 are evaluating outcomes for patients who have continuous ST-segment monitoring before arrival at a hospital; the results will be a helpful addition to current knowledge.…”

Section: Subjects and Recruitment Methodsmentioning

confidence: 99%

National Survey of Cardiologists’ Standard of Practice for Continuous ST-Segment Monitoring

Sandau

Sendelbach

Frederickson

et al. 2010

American Journal of Critical Care

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Background Continuous ST-segment monitoring can be used to detect early and transient cardiac ischemia. The American Heart Association and American Association of Critical-Care Nurses recommend its use among specific patients, but such monitoring is routine practice in only about half of US hospitals. Objective To determine cardiologists’ awareness and practice standards regarding continuous ST-segment monitoring and the physicians’ perceptions of appropriate patient selection, benefits and barriers, and usefulness of this technology. Methods An electronic survey was sent to a random sample of 915 US cardiologists from a pool of 4985 certified cardiologists. Results Of 200 responding cardiologists, 55% were unaware of the consensus guidelines. Of hospitals where respondents admitted patients, 49% had a standard of practice for using continuous ST-segment monitoring for cardiac patients. Most cardiologists agreed or strongly agreed that patients in the cardiovascular laboratory (87.5%) and intensive care unit (80.5%) should have such monitoring. Cardiologists routinely ordered ST monitoring for patients with acute coronary syndrome (67%) and after percutaneous coronary intervention (60%). The primary factor associated with higher perceptions for benefits, clinical usefulness, and past use of continuous ST-segment monitoring was whether or not hospitals in which cardiologists practiced had a standard of practice for using this monitoring. A secondary factor was awareness of published consensus guidelines for such monitoring. Conclusion Respondents (55%) were unaware of published monitoring guidelines. Hospital leaders could raise awareness by multidisciplinary review of evidence and possibly incorporating continuous ST-segment monitoring into hospitals’ standards of practice.

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Pre-hospital synthesized 12-lead ECG ischemia monitoring with trans-telephonic transmission in acute coronary syndromes

Cited by 32 publications

References 5 publications

Detection of acute myocardial ischemic injury by gender using a novel cardiac electrical biomarker

Detection of acute myocardial ischemic injury by gender using a novel cardiac electrical biomarker

Implementation and Integration of Prehospital ECGs Into Systems of Care for Acute Coronary Syndrome

National Survey of Cardiologists’ Standard of Practice for Continuous ST-Segment Monitoring

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