Tele-electrocardiography in Emergency Cardiac Care

远程心电图在心脏急救中的应用

• 批准号: 6930950
• 负责人: BARBARA J DREW
• 金额: $ 42.9万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
• 依托单位国家: 美国
• 财政年份: 2003
• 资助国家: 美国
• 起止时间: 2003-09-15 至 2008-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6930950
• 关键词: angina pectoris; clinical research; clinical trials; coronary disorder; electrocardiography; emergency care; emergency health services; health care transport service; human subject; myocardial infarction; patient oriented research; telemedicine

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.

描述（由申请人提供）：该项目旨在确定如果医院临床医生获得 1) 更早和 2) 更完整的心电图信息，因急性心肌梗塞 (MI) 或不稳定心绞痛进入“911”紧急医疗系统 (EMS) 的个人是否会得到更及时的住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 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 电极配置，以及 (2) 通过手机远程心电图将心电图从现场传输到急诊室 (ED)，而不是等待到达医院后获取心电图。更完整的心电图信息将通过 3 种方式获得：1) 通过连续监测而不是记录一次性心电图，2) 通过监测所有 12 个心电图导联，而不是单个导联，以及 (3) 通过使用特殊的缺血检测软件进行监测，而不是单独的心律失常软件。该软件将连续分析所有12个心电图导联的ST段以了解急性缺血的变化，并在发生ST事件时自动打印出急诊室的心电图。这种远程心电图干预将通过圣克鲁斯县的 EMS 在北加州作为全县范围的计划实施。 这项前瞻性、随机对照临床试验将总共招募 2,468 名受试者。受试者将被随机分为两组：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。要测试的假设是，与常规 EMS 对照组的患者相比，随机分配到 ST SMART 干预实验组的患者将：（1）尽管获得了更多心电图信息，但不再需要护理人员现场时间，（2）减少了急性冠脉综合征的治疗时间，以及（3）在医院和出院后一年内的不良后果更少。