Impact of the prehospital ECG on door‐to‐balloon time in ST elevation myocardial infarction

Rao, Anjani; Kardouh, Youssef; Darda, Saba; Desai, Devang; Devireddy, Lingareddy; LaLonde, Thomas; Rosman, Howard; David, Shukri

doi:10.1002/ccd.22257

Cited by 49 publications

(30 citation statements)

References 10 publications

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“…Several studies in the literature have shown improved reperfusion times in patients with STEMI when PH ECG is acquired. [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16] LeMay et al 11 instituted a citywide protocol in Ottawa for STEMI management. They included paramedic interpretation, activation, and direct patient transport to the city's cardiac care center rather than any of the city's 4 hospital EDs, with a median DTB of 69 minutes.…”

Section: Discussionmentioning

confidence: 99%

“…They included paramedic interpretation, activation, and direct patient transport to the city's cardiac care center rather than any of the city's 4 hospital EDs, with a median DTB of 69 minutes. Rao et al 15 published a report on a prehospital STEMI protocol using wireless transmission, in which the ED physician interpreted the ECG and activated the catheterization laboratory before patient arrival, and their median DTB was 60 minutes. Camp-Rogers et al 3 reported a mean DTB of 49 minutes when paramedics reviewed electronic ECG interpretations and activated the laboratory in the prehospital setting, but they did not bypass the ED for any patients.…”

Section: Discussionmentioning

confidence: 99%

“…[1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16] However, even when PH ECG are acquired, they may not be optimally utilized and integrated. A recent scientific statement by the American Heart Association (AHA) stated, "the central challenge for healthcare providers is not to simply perform PH ECG, but to use and integrate the diagnostic information from a PH ECG with systems of care."…”

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confidence: 99%

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Impact of Prehospital Electrocardiogram Protocol and Immediate Catheterization Team Activation for Patients With ST-Elevation–Myocardial Infarction

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Rihal

et al. 2011

Circ: Cardiovascular Quality and Outcomes

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Impact of Prehospital Electrocardiogram Protocol and Immediate Catheterization Team Activation for Patients With ST-Elevation–Myocardial Infarction

Nestler

White

Rihal

et al. 2011

Circ: Cardiovascular Quality and Outcomes

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“…1) The accurate diagnosis of STEMI is critical for quick and efficient treatment [2][3][4] and 12-lead electrocardiography (ECG) transmission in the pre-hospital time period could contribute to reducing the door-to-balloon time. [5][6][7][8][9][10][11][12] However, few Japanese ambulances are currently equipped with an ECG transfer system. In Japan, the medical-related activities of emergency lifesaving technicians in the field is strictly controlled by the law.…”

Section: P Atients With St-segment Elevation Myocardial Infarctionmentioning

confidence: 99%

Impact of Doctor Car with Mobile Cloud ECG in Reducing Door-to- Balloon Time of Japanese ST-Elevation Myocardial Infarction Patients

et al. 2015

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SummaryEarly reperfusion by percutaneous coronary intervention (PCI) is the current standard therapy for ST-elevation myocardial infarction (STEMI). To achieve better prognoses for these patients, reducing the door-to-balloon time is essential. As we reported previously, the Kitasato University Hospital Doctor Car (DC), an ambulance with a physician on board, is equipped with a novel mobile cloud 12-lead ECG system. Between September 2011 and August 2013, there were 260 emergency dispatches of our Doctor Car, of which 55 were for suspected acute myocardial infarction with chest pain and cold sweat. Among these 55 calls, 32 patients received emergent PCI due to STEMI (DC Group). We compared their data with those of 76 STEMI patients who were transported directly to our hospital by ambulance around the same period (Non-DC Group). There were no differences in patient age, gender, underlying diseases, or Killip classification between the two groups. The door-to-balloon time in the DC group was 56.1 ± 13.7 minutes and 74.0 ± 14.1 minutes in the Non-DC Group (P < 0.0001). Maximum levels of CPK were 2899 ± 308 and 2876 ± 269 IU/L (P = 0.703), and those of CK-MB were 292 ± 360 and 295 ± 284 ng/mL (P = 0.423), respectively, in the 2 groups. The Doctor Car system with the Mobile Cloud ECG was useful for reducing the door-to-balloon time. (Int Heart J 2015; 56: 170-173)

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“…[2][3][4][5][6][7] However, efforts made only in hospitals are insuffi cient, and how quickly the prehospital information is used for preparation of emergent catheterization is very important. 2,8) Kitasato University Hospital has sent its Doctor Car to deal with cases of acute myocardial infarction.…”

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Initial Experience of Mobile Cloud ECG System Contributing to the Shortening of Door to Balloon Time in an Acute Myocardial Infarction Patient

et al. 2013

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SummaryIt is important for myocardial infarction patients to undergo immediate reperfusion of the affected coronary artery. In order to improve the prognosis, efforts to shorten the door to balloon time to within 90 minutes have been made. However, conventional methods such as faxing electrocardiograms (ECG) have not become widespread due to their high cost and lack of sharpness of the ECG. The "Doctor Car" (rapid response car system) of Kitasato University Hospital is now equipped with a Mobile Cloud ECG system. With this system, 12-lead ECG data obtained in the fi eld are transmitted to the cloud server via a standard mobile telephone network. Since it uses an existing phone network, the cost of this system is low and it is fairly reliable. Cardiologists at the hospital read the ECG waveforms on the cloud server and decide whether emergency cardiac catheterization is necessary. In our fi rst case using this Mobile Cloud ECG system, the door to balloon time could be shortened. (Int Heart J 2013; 54: 45-47) Key words: Doctor car system, Myocardial infarction, Percutaneous coronary intervention, Prehospital medicine T he hospital mortality rate of acute myocardial infarction has been decreased due to the introduction of reperfusion treatments. However, in both Japan and the United States, approximately one half of myocardial infarction patients die before arriving at the hospital. 1) Therefore, it is important to establish a system of cooperation between hospitals and regional emergency services, such as a 12-lead ECG transmission system.2) A variety of efforts to shorten the door to balloon time to within 90 minutes have been made, in order to reduce the size of the infarct and improve the prognosis in myocardial infarction patients.2-7) However, efforts made only in hospitals are insuffi cient, and how quickly the prehospital information is used for preparation of emergent catheterization is very important. 2,8) Kitasato University Hospital has sent its Doctor Car to deal with cases of acute myocardial infarction. However, until recently, cardiologists had read the ECG waveforms after the patient had arrived at the hospital and then prepared for the emergency catheterization because the doctors sent into the fi eld were not cardiologists but emergency physicians. We therefore decided to equip the Doctor Car with a newly developed Mobile Cloud ECG system as described in detail in a previously published report.9) With the Mobile Cloud ECG system (Cloud Cardiology ® , Labtech Co., Hungary), which has been approved as medical equipment in Japan, 12-lead ECGs are sent to a tablet PC via a Bluetooth connection. The ECG data are electronically transmitted to a secure cloud server in an encrypted manner via an existing mobile telephone network, and the data in the server can then be browsed from a personal computer after password authentication via a secure internet connection. Case ReportThe subject was a 46-year-old male with no medical history. At 12:43 pm, an ambulance was summoned due to chest pain he experienc...

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Impact of the prehospital ECG on door‐to‐balloon time in ST elevation myocardial infarction

Abstract: Utilizing the prehospital ECG as a tool to bypass ER triage significantly decreases D2B times in patients with STEMI. This technology has the potential to substantially expedite reperfusion therapy in patients with STEMI.

Cited by 49 publications

References 10 publications

Impact of Prehospital Electrocardiogram Protocol and Immediate Catheterization Team Activation for Patients With ST-Elevation–Myocardial Infarction

Impact of Prehospital Electrocardiogram Protocol and Immediate Catheterization Team Activation for Patients With ST-Elevation–Myocardial Infarction

Impact of Doctor Car with Mobile Cloud ECG in Reducing Door-to- Balloon Time of Japanese ST-Elevation Myocardial Infarction Patients

Initial Experience of Mobile Cloud ECG System Contributing to the Shortening of Door to Balloon Time in an Acute Myocardial Infarction Patient

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