The failure of years of experience with electrocardiographic transmission from paramedics to the hospital emergency department to reduce the delay from door to primary coronary intervention below the 90-minute threshold during acute myocardial infarction

Vaught, Creighton; Young, Dwayne; Bell, Samuel; Maynard, Charles; Gentry, Michael; Jacubowitz, Samuel; Leibrandt, Paul N.; Munsey, Denise; Savona, Michael R.; Wall, Thomas C.; Wagner, Galen S.

doi:10.1016/j.jelectrocard.2005.12.002

Cited by 14 publications

(3 citation statements)

References 21 publications

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“…Furthermore, because these data were collected for quality assurance purposes under a new institutional protocol, the DTB times seen with ED activation may be related to Hawthorne effect (differential performance under conditions of observation). Performance measures are frequently high under initial observation and decline over an extended period to a basal state 9 . An additional explanation may be that early notification of a positive OOH 12‐lead ECG streamlines ED throughput by rallying staff and resources prior to arrival.…”

Section: Discussionmentioning

confidence: 99%

A Comparison of Door‐to‐balloon Times and False‐positive Activations between Emergency Department and Out‐of‐hospital Activation of the Coronary Catheterization Team

Youngquist

Shah

Niemann

et al. 2008

Academic Emergency Medicine

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Objectives: The objectives were to compare the proportion of false-positive activations and intervention times between emergency department (ED) and field-based activation of the coronary catheterization laboratory (cath) team for emergency medical services (EMS) patients identified by out-of-hospital (OOH) 12-lead electrocardiogram (ECG) with ST-segment elevation myocardial infarction (STEMI).Methods: This was a retrospective review of prospectively collected continuous quality improvement data at a single, urban, academic medical center. By protocol, weekday activation of the cath team occurred based on OOH notification of a computer-interpreted OOH ECG indicating potential STEMI. Night and weekend activation occurred at the discretion of the attending emergency physician (EP) after advanced ED notification and after patient arrival and assessment. Basic demographic information and cardiac risk factors were recorded, as well as door-to-balloon (DTB) and ultimate diagnosis. Results: From May 2007 through March 2008, there were 23 field activations and 33 ED activations.There was no difference in demographic or clinical characteristics between the two groups. In the field activation group, 9 ⁄ 23 (39%) were false-positives, while 3 ⁄ 33 (9%) were false-positives in the ED activation group (30% higher absolute difference in the field activation group, 95% confidence interval [CI] = 8% to 52%, p = 0.02). OOH times and time spent in the ED were similar between the two groups. DTB times were 77 minutes for field activation and 68 minutes for ED activation, respectively (difference 9 minutes, 95% CI = )9 to 27).Conclusions: Emergency physician activation of the cath team results in a lower proportion of falsepositive activations without clearly sacrificing DTB time when compared to field activation based solely on the results of the OOH ECG.ACADEMIC EMERGENCY MEDICINE 2008; 15:784-787 ª

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Section: Discussionmentioning

confidence: 99%

A Comparison of Door‐to‐balloon Times and False‐positive Activations between Emergency Department and Out‐of‐hospital Activation of the Coronary Catheterization Team

Youngquist

Shah

Niemann

et al. 2008

Academic Emergency Medicine

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show abstract

“…In patients with suspected ACS, a 12 lead ECG should be acquired and interpreted in the pre‐hospital emergency setting as soon as possible after first medical contact 14–18 . If the interpretation for pre‐hospital usage is not available by a trained non‐medical staff, field transmission of the ECG for expert interpretation is reasonable 19–31 . Further computer assisted interpretation of the ECG may increase the specific diagnosis, particularly in STEMI especially for clinicians less experienced in reading ECGs 32–34 .…”

Section: The 12 Lead Electrocardiographmentioning

confidence: 99%

Acute Coronary Syndromes: Presentation with ACS. ARC and NZRC Guideline 2011

2011

Emerg Medicine Australasia

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“…The record of EMS contributions from North Carolina is too long to list here. As examples, investigators in our state are producing new knowledge on the effectiveness of out-of-hospital electrocardiograms, 8 the role of EMS in public access defibrillation, 9 the duty of EMS in reporting domestic violence, 10 and the out-of-hospital care of stroke patients. 11 But much work remains.…”

Section: North Carolina's Role In Filling the Gapsmentioning

confidence: 99%