Accuracy of ECG Chest Electrode Placements by Paramedics; an observational study

Abstract

Background: The use of the 12-lead ECG is common in UK paramedic practice but its value depends upon accurate placement of the ECG-electrodes. Several studies have shown widespread variation in the placement of chest electrodes by other health professionals but no studies have addressed the accuracy of paramedics. The main objective of this study was to ascertain the accuracy of the chest lead placements by registered paramedics. Methods: Registered paramedics who attended the Emergency Services Show in Birmingham in September 2018 were invited to participate in this observational study. Participants were asked to place the chest electrodes on a male model in accordance with their current practice. Correct positioning was determined against the Society for Cardiological Science & Technology's Clinical Guidelines for recording a standard 12-lead electrocardiogram (2017) with a tolerance of 19mm being deemed acceptable based upon previous studies. Results: 52 eligible participants completed the study. Measurement of electrode placement in the craniocaudal and mediolateral planes showed a high level of inaccuracy with 3/52 (5.8%) participants able to accurately place all chest leads. In leads V1 - V3, the majority of incorrect placements were related to vertical displacement with most participants able to identify the correct horizontal position. In V4, the tendency was to place the lead too low and to the left of the pre-determined position whilst V5 tended to be below the expected positioning but in the correct horizontal alignment. There was a less defined pattern of error in V6 although vertical displacement was more likely than horizontal displacement. Conclusion: Our study identified a high level of variation in the placement of chest ECG electrodes which could alter the morphology of the ECG. From a patient safety perspective, we would advocate that paramedics leave the chest electrodes in situ to allow hospital staff to assess the accuracy of the placements.

Paramedic perspectives on sex and gender equity in prehospital electrocardiogram acquisition

“…38 The authors justify this choice by speculating that observed inaccuracies—already significant in a straight-forward case—would likely be greater had they introduced the “complexities” of female patients. 38 (p12)…”

“…Of note, a recent observational study assessed the accuracy of paramedic electrode placement using only a male volunteer. 38 The authors justify this choice by speculating that observed inaccuraciesalready significant in a straight-forward case-would likely be greater had they introduced the "complexities" of female patients. 38(p12) As with ECG acquisition, few studies have explored detailed reasons for observed gender gaps in acute prehospital cardiac care.…”

Mala colocación de electrodos: un desafío diagnóstico aún presente

“…En conclusión, no es rara la mala colocación de los electrodos. Se ha publicado que el 49% de las enfermeras y solo un 16% de los cardiólogos colocan adecuadamente los electrodos V1 y V2 14 , y que apenas un 5.8% de los paramédicos colocan todos los electrodos precordiales adecuadamente 15 . Una mala colocación de los electrodos durante el procedimiento de toma de un ECG sigue siendo un desafío diagnóstico.…”

Comparison of placement time duration between precordial lead of ECG Safone and Standard ECG

“…Displacement of precordial lead on the patient's chest sometimes occurs during ECG recording. A study by Gregory et al (2019) on the accuracy of ECG electrode placements reported a significant rate of inaccuracy with only 3 out of 52 participants (5.8%) able to place chest electrodes accurately. Another study by Medani, Hensey, Caples, and Owens (2018) found that only 10 out of 100 (10%) participants could accurately identify and place electrodes on the chest.…”