The diagnostic impact of prehospital 12-lead electrocardiography

Aufderheide, Tom P.; Hendley, Gail E; Thakur, Ranjan K.; Mateer, James R; Stueven, Harlan A; Olson, David; Hargarten, Kathleen M; Laitinen, Fred; Robinson, Nancy; Preuss, Kevin C.; Hoffman, Raymond G.

doi:10.1016/s0196-0644(05)82288-7

Cited by 91 publications

(16 citation statements)

References 39 publications

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“…3,4 Paramedics can achieve a high success rate (98.7%) in obtaining diagnostic quality pre-hospital 12-lead ECGs in the majority of patients, 5 and 12-lead ECGs can be transmitted from a moving ambulance using cellular telephones. 6 However,.…”

Section: Introductionmentioning

confidence: 99%

Diagnostic performance and potential clinical impact of advanced care paramedic interpretation of ST-segment elevation myocardial infarction in the field

May

Dionne

Maloney

et al. 2006

CJEM

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Objectives: Most studies of pre-hospital management of ST-elevation myocardial infarction (STEMI) have involved physicians accompanying the ambulance crew, or electrocardiogram (ECG) transmission to a physician at the base hospital. We sought to determine if Advanced Care Paramedics (ACPs) could accurately identify STEMI on the pre-hospital ECG and contribute to strategies that shorten time to reperfusion. Methods: A STEMI tool was developed to: 1) measure the accuracy of the ACPs at diagnosing STEMI; and 2) determine the potential time saved if ACPs were to independently administer thrombolytic therapy. Using registry data, we subsequently estimated the time saved by initiating thrombolytic therapy in the field compared with in-hospital administration by a physician. Results: Between August 2003 and July 2004, a correct diagnosis of STEMI on the pre-hospital ECG was confirmed in 63 patients. The performance of the ACPs in identifying STEMI on the ECG resulted in a sensitivity of 95% (95% confidence interval [CI] 86%-99%), a specificity of 96% (95% CI 94%-98%), a positive predictive value (PPV) of 82% (95% CI 71%-90%), and a negative predictive value (NPV) of 99% (95% CI 97%-100%). ACP performance for appropriately using thrombolytic therapy resulted in a sensitivity of 92% (95% CI 78%-98%), a specificity of 97% (95% CI 94%-98%), a PPV of 73% (95% CI 59%-85%) and an NPV of 99% (95% CI 97%-100%). We estimated that the median time saved by ACP administration of thrombolytic therapy would have been 44 minutes. Conclusions: ACPs can be trained to accurately interpret the pre-hospital ECG for the diagnosis of STEMI. These results are important for the design of regional integrated programs aimed at reducing delays to reperfusion. RÉSUMÉ Objectifs : La plupart des études sur la prise en charge préhospitalière des infarctus du myocarde avec élévation du segment S-T (IMEST) ont été faites dans un contexte où les médecins accompag- ORIGINAL RESEARCH • RECHERCHE ORIGINALE ADVANCES

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Section: Introductionmentioning

confidence: 99%

Diagnostic performance and potential clinical impact of advanced care paramedic interpretation of ST-segment elevation myocardial infarction in the field

May

Dionne

Maloney

et al. 2006

CJEM

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“…14,18 In a sample of 24 patients, most (96%) or all ST-segment elevations were present on both ECGs of STEMI patients, with one additional elevation on the hospital ECG alone (4% of elevations). 18 Among three NSTEMI patients in the other study, one ST-segment depression was noted, and this was present on the prehospital ECG only. 14 Drew and collaborators found, similar to our results, that tachyarrhythmias were more frequent on the prehospital ECG than the first hospital ECG.…”

Section: Discussionmentioning

confidence: 99%

“…There is some evidence that the prehospital ECG may detect signs of transient ischemia and arrhythmias, no longer present by the time of the first hospital ECG. [13][14][15][16][17][18][19] However, previous studies have used diverse patient selection criteria and provide widely varying results. The objective of this study was to examine the extent to which the prehospital ECG provides information on possible cardiac ischemia and arrhythmias when compared with the first hospital ECG.…”

Section: Introductionmentioning

confidence: 99%

Information on Myocardial Ischemia and Arrhythmias Added by Prehospital Electrocardiograms

Boothroyd

Segal²,

Bogaty³

et al. 2013

Prehospital Emergency Care

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“…In-hospital telecardiology is often used for electrocardiogram sharing between different departments or between peripheral hospitals to central hospitals 15–17 . The diagnostic quality of the images sent and received through the use of telemedicine has proved to be very high.…”

Section: Telemedicine In Arrhythmic Emergenciesmentioning

confidence: 99%

ANMCO/SIT Consensus Document: telemedicine for cardiovascular emergency networks

Caldarola

Gulizia

Gabrielli³

et al. 2017

European Heart Journal Supplements

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Telemedicine has deeply innovated the field of emergency cardiology, particularly the treatment of acute myocardial infarction. The ability to record an ECG in the early prehospital phase, thus avoiding any delay in diagnosing myocardial infarction with direct transfer to the cath-lab for primary angioplasty, has proven to significantly reduce treatment times and mortality. This consensus document aims to analyse the available evidence and organizational models based on a support by telemedicine, focusing on technical requirements, education, and legal aspects.

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The diagnostic impact of prehospital 12-lead electrocardiography

Cited by 91 publications

References 39 publications

Diagnostic performance and potential clinical impact of advanced care paramedic interpretation of ST-segment elevation myocardial infarction in the field

Diagnostic performance and potential clinical impact of advanced care paramedic interpretation of ST-segment elevation myocardial infarction in the field

Information on Myocardial Ischemia and Arrhythmias Added by Prehospital Electrocardiograms

ANMCO/SIT Consensus Document: telemedicine for cardiovascular emergency networks

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