Tele-electrocardiography in Emergency Cardiac Care

描述（由申请人提供）：该项目旨在确定如果医院临床医生能够1）更早和2）更完整地提供ECG信息，则访问“911”紧急医疗系统（EMS）的急性心肌梗死（MI）或不稳定型心绞痛患者是否会获得更及时的医院治疗和更好的结局。早期EKG信息将通过两种方式获得：（1）通过从快速应用的5电极配置合成12导联ECG，而不是使用标准12导联ECG所需的麻烦的10电极配置，以及（2）通过手机远程心电图术将ECG从现场传输到急诊科（艾德）而不是等到到达医院后才进行心电图检查。将通过3种方式获得更完整的ECG信息：1）通过连续监测而不是记录一次性ECG，2）通过监测所有12个EKG导联而不是单个导联，以及（3）通过使用特殊缺血检测软件而不是单独的心律失常软件进行监测。该软件将连续分析所有12个ECG导联中的ST段，以了解急性缺血的变化，并在ST事件发生时自动打印出艾德中的ECG。该远程心电图干预将通过圣克鲁斯县的EMS在北方加州作为一个县范围的项目实施。 本前瞻性随机对照临床试验将招募共计2，468例受试者。受试者将被随机分配到两组之一：1）实验组将接受院前远程心电图干预，2）对照组将接受常规EMS心脏护理。待检验的假设是，与常规EMS对照组的患者相比，随机分配至ST SMART干预实验组的患者将：（1）尽管获得了更多的ECG信息，但不再有护理现场时间，（2）缩短了急性冠状动脉综合征的治疗时间，（3）减少了住院和出院后一年的不良结局。

DESCRIPTION (provided by applicant): This project which seeks to determine whether individuals who access the "911" emergency medical system (EMS) with acute myocardial infarction (MI) or unstable angina will receive more timely hospital treatment and better outcomes if hospital clinicians are provided with 1) earlier, and 2) more complete ECG information. Earlier EKG information will be achieved in 2 ways: (1) by synthesizing a 12-lead ECG from a rapidly applied 5 electrode configuration, rather than using the cumbersome 10- electrode configuration required for a standard 12 lead ECG, and (2) by transmitting ECGs by cell phone tele-electrocardiography) from the field to the emergency department (ED) rather than waiting to obtain an ECG after hospital arrival. More complete ECG information will be achieved in 3 ways 1) by monitoring continuously rather than recording a one-time ECG, 2) by monitoring all 12 EKG leads, rather than a single lead, and (3) by monitoring with special ischemia detection software, rather than arrhythmia software alone. The software will continuously analyze ST segments in all 12 ECG leads for changes of acute ischemia and will automatically print out ECGs in the ED when ST events occur. This tele-electrocardiography intervention will be implemented as a county wide program in Northern California through Santa Cruz County's EMS. A total of 2,468 subjects will be recruited for this prospective, randomized controlled clinical trial. Subjects will be randomized to one of two groups: 1) the experimental group will have the pre-hospital tele-electrocardiography intervention and 2) the control group will have routine EMS cardiac care. Hypotheses to be tested are that patients randomized to the ST SMART intervention experimental group will, in comparison to patients in the routine EMS control group have: (1) no longer paramedic scene times, despite the acquisition of more ECG information, (2) reduced time to treatment for acute coronary syndromes, and (3) fewer adverse outcomes in the hospital and at one year following hospital discharge.