The utility of the prehospital electrocardiogram

Abstract

Objectives: The 12-lead electrocardiogram (ECG) can capture valuable information in the prehospital setting. By the time patients are assessed by an emergency department (ED) physician, their symptoms and any ECG changes may have resolved. We sought to determine whether the prehospital electrocardiogram (pECG) could influence ED management and how often the pECG was available to and reviewed by the ED physician. Methods: A retrospective medical record review was conducted on a random sample of patients $ 18 years who had a prehospital 12-lead ECG and were transported to one of two tertiary care centres. Data were recorded onto a standardized data extraction tool. Three investigators independently compared the pECG to the first ECG obtained in the ED after patient arrival at the hospital. Any abnormalities not present on the ED ECG were adjudicated to ascertain whether they had the potential to change ED management. Results: Of 115 ambulance runs selected, 47 had no pECG attached to the ambulance call record (ACR) and another 5 were excluded (one ST elevation myocardial infarction, one cardiac arrest, three ACR missing). Of the 63 pECGs reviewed, 16 (25%) showed changes not apparent on the initial ED ECG (k 5 0.83; 95% CI 0.74-0.93), of which 12 had differences that might influence ED management (k 5 0.76; 95% CI 0.72-0.82). Only one hospital record contained a copy of the pECG, despite the current protocol that paramedics print two copies of the pECG on arrival in the ED (one copy for the ACR and one to be handed to the medical personnel). None of 110 ED charts documented that the pECG was reviewed by the ED physician. Conclusion: The pECG has the potential to influence ED management. Improvement in paramedic and physician documentation and a formal pECG handover process appear necessary. RÉ SUMÉObjectifs : L'é lectrocardiogramme (ECG) à 12 dé rivations peut fournir des renseignements pré cieux en contexte de pré hospitalisation. En effet, avant que les patients n'aient é té é valué s par un mé decin du service des urgences (SU), leurs symptô mes et toute modification de l'ECG pourraient avoir é té dé jà ré solus. Nous cherchions donc à dé terminer si l'é lectrocardiogramme en pré hospitalisation (ECGp) pouvait influencer la prise en charge du patient au SU et à quelle fré quence il é tait mis à la disponibilité du mé decin du SU afin qu'il puisse l'é tudier. Mé thodes : Un examen ré trospectif des dossiers mé dicaux a é té mené sur un é chantillon alé atoire de patients de plus de 18 ans soumis à un ECG à 12 dé rivations et transporté s dans un des deux centres de soins tertiaires. Les donné es ont é té consigné es sur un instrument normalisé d'extraction de donné es. Trois chercheurs ont comparé sé paré ment l'ECGp avec le premier ECG obtenu au SU aprè s l'arrivé e du patient à l'hô pital. Toute anomalie absente de l'ECG du SU a é té examiné e afin de vé rifier si elle pouvait avoir modifié la prise en charge du patient par le SU. Ré sultats : Pour 115 transports par ambulance sé lectionné s, il n'y av...

Impact of transport pathways on the time from symptom onset of ST-segment elevation myocardial infarction to door of coronary intervention facility

“…Despite these prior paradoxical data, efforts to shorten the total ischemic time for STEMI patients could improve overall mortality rate. To achieve more prompt and accurate triage, various novel approaches such as pre-hospital electrocardiogram or pre-hospital troponin T testing have been attempted and their effects reported [28][29][30][31][32][33][34][35].…”

Outcomes by Mode of Transport of ST Elevation MI Patients in the United Arab Emirates

“…Prehospital ECG may also detect signs of transient ischemia and arrhythmias, which may no longer be present when the patient receives the first in-hospital ECG 21,22…”

Information on Myocardial Ischemia and Arrhythmias Added by Prehospital Electrocardiograms

“…13 Recently, 19% of a random sample of 63 patients who had prehospital ECGs displayed ischemic abnormalities (STsegment depression or T-wave inversion) not present on the initial in-hospital ECG that were considered by emergency department physicians to have had the potential to influence management. 19 All 12 patients had received oxygen, aspirin, and/or nitroglycerin before hospital arrival. A study of serial prehospital ECGs likewise demonstrated evolution of diagnostic information, over a short period of time: for patients who had multiple tracings because the initial field ECG was nondiagnostic, in 15% additional STEMIs were detected by subsequent prehospital ECGs (acquired within 25 minutes after the first ECG for 90% of these patients).…”

“…There is some evidence that the prehospital ECG may detect signs of transient ischemia and arrhythmias, no longer present by the time of the first hospital ECG. [13][14][15][16][17][18][19] However, previous studies have used diverse patient selection criteria and provide widely varying results. The objective of this study was to examine the extent to which the prehospital ECG provides information on possible cardiac ischemia and arrhythmias when compared with the first hospital ECG.…”