Diagnostic performance and system delay using telemedicine for prehospital diagnosis in triaging and treatment of STEMI

Rasmussen, Martin Boehme; Frost, Lars; Stengaard, Carsten; Brorholt-Petersen, Jens Uffe; Dodt, Karen Kaae; Søndergaard, Hanne Maare; Terkelsen, Christian Juhl

doi:10.1136/heartjnl-2013-304576

Cited by 55 publications

(37 citation statements)

References 19 publications

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“…Therefore there is an upper time limit for the transport of the patient to the PPCI capable hospital [24]. One solution to this dilemma is to introduce PPCI facilities with a closer proximity.…”

Section: Prehospital Ecg Diagnosis Of Patients With St Elevation Myocmentioning

confidence: 99%

“…However, living in the close proximity of the PPCI center seems to be outweighed by the reduced amount of time to prepare for the patient. This results in a longer door-to-balloon delay, Figure 4 [24]. Even in an optimal setting, the system delay is a median of 80 min for those living in the near vicinity of the PPCI center.…”

Section: Prehospital Ecg Diagnosis Of Patients With St Elevation Myocmentioning

confidence: 99%

“…In an optimal setting where telemedicine prehospital diagnosis and rerouting is used, patients with driving distances up to 100 km may be treated within the 120 min advised by the guidelines. From [24]. Reproduced with permission.…”

Section: Prehospital Ecg Diagnosis Of Patients With St Elevation Myocmentioning

confidence: 99%

“…In addition to false negative ECG interpretation, false positive activation of the catheterization laboratory is a particular problem. Experience from our center, indicates that 80%-85% of patients triaged to our center for PPCI ultimately have STEMI, but also that 96% of all catheterization laboratory activations were deemed appropriate [24,48]. Patients, who are falsely triaged for PPCI essentially end up having an unnecessary CAG performed, are treated with antithrombotic and anticoagulant medications and the time needed to perform the CAG delays additional diagnostic initiatives.…”

Section: Prehospital Ecg Diagnosis Of Patients With St Elevation Myocmentioning

confidence: 99%

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Prehospital diagnosis of patients with acute myocardial infarction

et al. 2016

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Primary percutaneous intervention (PPCI) is the preferred treatment in patients with ST elevation myocardial infarction (STEMI) if this can be performed in a timely manner. The 2012 ESC Guidelines on management of AMI in patients presenting with ST-segment elevation advice that PPCI should be performed within 120 min of first medical contact. Prehospital diagnosis of patients with STEMI is performed to save time and make PPCI available to the majority of patients. Although diagnosing patients with STEMI is usually easy, there are important pitfalls and patients with STEMI are missed on occasion. In addition, it is well know that patients without ST elevation may also have a high-risk cardiac condition. The 2015 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation stress the importance of urgent CAG in patients with high-risk non ST-segment elevation myocardial infarction (NSTEMI). Unfortunately, these patients are difficult to diagnose in the acute phase and important time may be spend establishing the correct diagnosis. Prehospital biomarker measurement has emerged as a method to gain important additional information. We review the evidence on prehospital diagnosis of patients with STEMI and, In addition, we present the current knowledge on the new diagnostic methods that could have a future role in prehospital rule-in and rule-out of cardiac disease.

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Section: Prehospital Ecg Diagnosis Of Patients With St Elevation Myocmentioning

confidence: 99%

Section: Prehospital Ecg Diagnosis Of Patients With St Elevation Myocmentioning

confidence: 99%

Section: Prehospital Ecg Diagnosis Of Patients With St Elevation Myocmentioning

confidence: 99%

Section: Prehospital Ecg Diagnosis Of Patients With St Elevation Myocmentioning

confidence: 99%

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Prehospital diagnosis of patients with acute myocardial infarction

et al. 2016

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“…For the time interval between first medical contact and “balloon”, a 120 min limit has been used but in our analysis, we used the time interval between symptom onset to “balloon”. Based on a study of similar patients from Denmark, we added 30 min (estimated time from symptom onset to first medical contact) to the 120 min and used 150 min as the cut‐off in the analysis13.…”

Section: Methodsmentioning

confidence: 99%

Helicopter vs. ground transportation of patients bound for primary percutaneous coronary intervention

Funder

Rasmussen

Siersma

et al. 2018

Acta Anaesthesiol Scand

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BackgroundImplementation of the first Danish helicopter emergency medical service (HEMS) was associated with reduced time from first medical contact to treatment at a specialized centre for patients with suspected ST elevation myocardial infarction (STEMI). We aimed to investigate effects of HEMS on mortality and labour market affiliation in patients admitted for primary percutaneous coronary intervention (PCI).MethodsIn this prospective observational study, we included patients with suspected STEMI within the region covered by the HEMS from January 1, 2010, to April 30, 2013, transported by either HEMS or ground emergency medical services (GEMS) to the regional PCI centre. The primary outcome was 30‐day mortality.ResultsAmong the 384 HEMS and 1220 GEMS patients, time from diagnostic ECG to PCI centre arrival was lower with HEMS (median 71 min vs. 78 min with GEMS; P = 0.004). Thirty‐day mortality was 5.0% and 6.2%, respectively (adjusted OR = 0.82, 95% CI 0.44–1.51, P = 0.52. Involuntary early retirement rates were 0.62 (HEMS) and 0.94 (GEMS) per 100 PYR (adjusted IRR = 0.68, 0.15–3.23, P = 0.63). The proportion of patients on social transfer payments longer than half of the follow‐up time was 22.1% (HEMS) vs. 21.2% (adjusted OR = 1.10, 0.64–1.90, P = 0.73).ConclusionIn an observational study of patients with suspected STEMI in eastern Denmark, no significant beneficial effect of helicopter transport could be detected on mortality, premature labour market exit or work ability. Only a study with random allocation to one system vs. another, along with a large sample size, will allow determination of superiority of helicopter transport.

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A physician‐staffed ground emergency medical service does not significantly shorten door‐to‐balloon time in patients with STEMI: an observational study in a single emergency center in Japan

Yoshioka

Teshima

Gamo

et al. 2020

Acute Medicine & Surgery

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Aim Current guidelines recommend a door‐to‐balloon time (DTBT) of <90 min for reperfusion treatment of patients with ST‐segment elevation myocardial infarction (STEMI). A physician‐staffed ground emergency medical service (GEMS) using a rapid response car (RRC) system was implemented at our hospital in April 2015. The medical team, including a physician and nurse, is dispatched to assess the patient and expedite the start of treatment by emergency physicians and cardiologists after arrival at the hospital. The study aimed to determine whether the RRC system shortened the DTBT. Methods This retrospective observational study was carried out in a tertiary emergency center in Japan. Those STEMI patients with primary percutaneous intervention between January 2016 and December 2018 were evaluated. The DTBTs of patients transported by the RRC system, the emergency medical service (EMS), and transferred from other hospitals after STEMI diagnosis (TRANS group) were compared. Results A total of 121 patients were included, 33 in the RCC, 20 in the EMS, and 68 in the TRANS groups. The median DTBT was 51 min (interquartile range [IQR], 43–67) in the RRC, 61 min (IQR, 52–85) in the EMS, and 59 min (IQR, 48–72) in the TRANS groups ( P = 0.13). The DTBT was not significantly shorter in the RRC than in the other groups. Conclusion An RRC physician‐staffed GEMS did not significantly shorten the DTBT of patients with STEMI compared with other transport systems.

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Diagnostic performance and system delay using telemedicine for prehospital diagnosis in triaging and treatment of STEMI

Cited by 55 publications

References 19 publications

Prehospital diagnosis of patients with acute myocardial infarction

Prehospital diagnosis of patients with acute myocardial infarction

Helicopter vs. ground transportation of patients bound for primary percutaneous coronary intervention

A physician‐staffed ground emergency medical service does not significantly shorten door‐to‐balloon time in patients with STEMI: an observational study in a single emergency center in Japan

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