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Paramedic Pre-Hospital ECG Reading Helps ST-Elevation MI Patients: Presented at AHA

By Jill Stein

DALLAS, TX -- November 15, 2005 -- The ability to perform and interpret an electrocardiogram (ECG) by emergency medical service (EMS) personnel cuts the time to catheterization, length of hospital stay and mortality in patients with ST-elevation myocardial infarction (STEMI).

These findings were presented here on November 14^th at the American Heart Association's Scientific Sessions 2005 (AHA).

Robert O'Connor, MD, Program Director and Director of Education and Research, Christiana Care Health System, Newark, Delaware, and colleagues assessed whether acquisition of an ECG by EMS personnel would decrease the time to treatment and overall survival in patients with STEMI.

"Early diagnosis of acute MI is a priority during the in-hospital management of the patients with chest pain in order to enable early thrombolysis," Dr. O'Connor said. "A logical extension of early diagnosis is pre-hospital recognition of the ECG criteria for thrombolysis by ambulance service paramedics."

"Pre-hospital advanced life support providers, who are already accustomed to ECG rhythm monitoring, have readily mastered the technique of performing a 12-lead ECG," he explained. "In addition, ECG evaluation of patients with chest discomfort in the out-of-hospital (EMS) setting is advocated as a Class I recommendation by the American Heart Association."

"Transmission of an ECG requires technology at both ends of the transmission, a fault-free line, the immediate availability of a senior doctor to make the diagnosis, and a system for communicating the diagnosis back to the ambulance crew," he continued. "Transmission is very likely to experience difficulties with communication, may result in delay, and requires expensive technology. Transmission problems can be avoided if the paramedic can recognize ST segment elevation."

The investigators conducted a study of 1283 consecutive patients who were transported by ambulance to a tertiary care, community teaching hospital after calling 911 with a chief complaint of chest pain.

Subjects were assigned to case or control depending on whether or not they had an ECG performed by EMS. The decision to perform a pre-hospital ECG depended on the type of EMS service or was discretionary. Paramedic or emergency physician identification of STEMI on ECG triggered immediate activation of the catheterization laboratory.

The study excluded patients who sustained a cardiac arrest prior to intervention and patients with a chief complaint other than chest discomfort.

A total of 1283 patients who had ECGs performed by EMS personnel and 269 emergency department cases were included in the analysis. For EMS ECG, there were 51 deaths (4.0%) versus 25 (9.3%) in the control group.

Mean hospital length of stay was shorter for EMS ECG cases (5.1 vs. 6.4 days). Mean time from arrival at the emergency room to admission to the catheterization laboratory (73 vs. 111 minutes, P = .0003) and mean time to balloon inflation (88 vs. 128 minutes, P < .0001) were shorter in the EMS ECG group.

Based on the results, Dr. O'Connor urged that EMS systems consider implementing pre-hospital ECG programs to decrease the time to intervention and mortality.


[Presentation title: Performance and Interpretation of the Pre-Hospital ECG by Paramedics is Associated With a Reduced Time to Intervention, Shorter Hospital Length of Stay, and Reduced Mortality. Abstract 2108]

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