Tele-electrocardiography in Emergency Cardiac Care

描述（由申请人提供）：本项目旨在确定使用“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，如果向医院临床医生提供1)更早，2)更完整的心电图信息，是否会得到更及时的医院治疗和更好的结果。早期的心电图信息将通过两种方式获得：(1)通过快速应用的5个电极配置合成12导联心电图，而不是使用标准12导联心电图所需的繁琐的10个电极配置；(2)通过手机远程心电图从现场传输到急诊科（ED），而不是在医院到达后等待获得心电图。更完整的心电图信息可以通过3种方式获得：1)连续监测而不是一次性记录心电图；2)监测所有12条心电图导联，而不是单个导联；3)使用专门的缺血检测软件监测，而不是单独使用心律失常软件。软件将连续分析所有12导联ST段的急性缺血变化，并在ST事件发生时自动打印出ED中的心电图。这种远程心电图干预将通过圣克鲁斯县的EMS在北加州全县范围内实施。这项前瞻性、随机对照临床试验共招募2468名受试者。将受试者随机分为两组：1)实验组院前远程心电图干预，2)对照组常规EMS心脏护理。有待检验的假设是，与常规EMS对照组相比，随机分配到ST SMART干预实验组的患者将：(1)尽管获得了更多的心电图信息，但不再有护理现场次数；(2)缩短了急性冠状动脉综合征的治疗时间；(3)在医院和出院后一年的不良后果更少。

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.