e-Transmission of ECGs for expert consultation results in improved triage and treatment of patients with acute ischaemic chest pain by ambulance paramedics

Aims In pre-hospital settings handled by paramedics, identification of patients with myocardial infarction (MI) remains challenging when automated electrocardiogram (ECG) interpretation is inconclusive. We aimed to identify those patients and to get them on the right track to primary percutaneous co...

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Bibliographic Details
Published in:Netherlands heart journal 2018-11, Vol.26 (11), p.562-571
Main Authors: Anroedh, S. S., Kardys, I., Akkerhuis, K. M., Biekart, M., van der Hulst, B., Deddens, G. J., Smits, P., Gardien, M., Dubois, E., Zijlstra, F., Boersma, E.
Format: Article
Language:English
Subjects:
Acute coronary syndromes
Angioplasty
Automation
Cardiology
Clinical outcomes
Electrocardiography
Heart attacks
Ischemia
Medical diagnosis
Medical Education
Medical imaging
Medical records
Medicine
Medicine & Public Health
Mortality
Original
Original Article
Pain
Paramedics
Patients
Software
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Summary:Aims In pre-hospital settings handled by paramedics, identification of patients with myocardial infarction (MI) remains challenging when automated electrocardiogram (ECG) interpretation is inconclusive. We aimed to identify those patients and to get them on the right track to primary percutaneous coronary intervention (PCI). Methods and results In the Rotterdam-Rijnmond region, automated ECG devices on all ambulances were supplemented with a modem, enabling transmission of ECGs for online expert interpretation. The diagnostic protocol for acute chest pain was modified and monitored for 1 year. Patients with an ECG that met the criteria for ST-elevation myocardial infarction (STEMI) were immediately transported to a PCI hospital. ECGs that did not meet the STEMI criteria, but showed total ST deviation ≥800 µv were transmitted for online interpretation by the ECG expert. Online supervision was offered as a service if ECGs showed conduction disorders, or had an otherwise ‘suspicious’ pattern according to the ambulance paramedics. We enrolled 1,076 patients with acute ischaemic chest pain who did not meet the automated STEMI criteria. Their mean age was 63 years; 64% were men. After online consultation, 735 (68%) patients were directly transported to a PCI hospital for further treatment. PCI within 90 min was performed in 115 patients. Conclusion During a 1-year evaluation of the modified pre-hospital triage protocol for patients with acute ischaemic chest pain, over 100 acute MI patients with an initially inconclusive ECG received primary PCI within 90 min. Because of these results, we decided to continue the operation of the modified protocol.
ISSN:1568-5888
1876-6250
DOI:10.1007/s12471-018-1187-0