Effect on treatment delay of prehospital teletransmission of 12-lead electrocardiogram to a cardiologist for immediate triage and direct referral of patients with ST-segment elevation acute myocardial infarction to primary percutaneous coronary intervention
Effect on treatment delay of prehospital teletransmission of 12-lead electrocardiogram to a cardiologist for immediate triage and direct referral of patients with ST-segment elevation acute myocardial infarction to primary percutaneous coronary intervention
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DOI：
10.1016/j.amjcard.2007.11.038
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发表时间：
2008-04-01
影响因子：
2.8
通讯作者：
Clemmensen, Peter
中科院分区：
文献类型：
--
作者：
Sejersten, Maria;Sillesen, Martin;Clemmensen, Peter
院前心电图传输到医院可以减少急性心肌梗死患者的治疗时间。然而，新技术允许直接传输到移动单元，因此主治医生可以做出反应，而不管医院内外是否存在。该研究的主要目的是确定是否可以通过将院前12导联心电直接传输到主治医生的移动电话以进行快速分诊并将其传输到初级经皮冠状动脉介入治疗(PCI)中心，从而减少城市地区的延误，绕过当地医院和急诊室。第二个目的是说明尽管运输时间较长，运输是否安全。在两年的时间里，患有急性非创伤性胸痛的患者将他们的院前心电图直接传输到心脏病专家的移动电话上。治疗时间与历史对照进行比较。在心电图评估后，168名患者(30%)直接转诊为经皮冠状动脉介入治疗，其中146名患者(87%)接受了紧急导尿术。在转诊的患者中，从911呼叫到经皮冠状动脉介入治疗的中位时间显著短于对照组(74vs127分钟；p<；0.001)。相应地，转诊患者到经皮冠状动脉介入治疗的时间比对照组缩短了63分钟(34比97分钟；p<；0.001)。在运输过程中，7名患者(4%)经历了室颤；3名患者(2%)经历了室性心动过速；1名患者(0.5%)经历了无脉搏电活动，其中2名患者(1%)死于难治性心律失常。总而言之，院前12导联心电图直接传输到主治医生的移动电话的情况减少了。当患者绕过当地医院被直接运送到介入治疗中心时，门到介入治疗的时间缩短了>；1小时。尽管运输时间较长，但救护车运输似乎是安全的。(C)2008年爱思唯尔公司。
Prehospital electrocardiogram (ECG) transmission to hospitals was shown to reduce time to treatment in patients with acute myocardial infarction. However, new technologies allow transmission directly to a mobile unit so an attending physician can respond irrespective of presence within or outside the hospital. The primary study purpose was to determine whether delays could be decreased in an urban area by transmitting a prehospital 12-lead ECG directly to the attending cardiologist's mobile telephone for rapid triage and transport to a primary percutaneous coronary intervention (PCI) center, bypassing local hospitals and emergency departments. A secondary purpose was to describe whether transport would be safe despite longer transport times. During a 2-year period, patients with acute nontraumatic chest pain had their prehospital ECG transmitted directly to a cardiologist's mobile telephone. Time to treatment was compared with historic controls. After ECG evaluation, 168 patients (30%) were referred directly for PCI, and 146 of these (87%) underwent emergent catheterization. In referred patients, median time from 911 call to PCI was significantly shorter than in the control group (74 vs 127 minutes; p < 0.001). Accordingly, door-to-PCI time was 63 minutes shorter for referred patients versus controls (34 vs 97 minutes; p < 0.001). During transport, 7 patients (4%) experienced ventricular fibrillation; 3 patients (2%), ventricular tachycardia; and 1 patient (0.5%), pulseless electrical activity, including 2 deaths (1%) caused by treatment-resistant arrhythmia. In conclusion, transmission of a prehospital 12-lead ECG directly to the attending cardiologist's mobile telephone decreased. door-to-PCI time by > 1 hour When patients were transported directly to PCI centers, bypassing local hospitals. Ambulance transport seems safe despite longer transport times. (C) 2008 Elsevier Inc.