Coronary artery diseaseEffect 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
Section snippets
Methods
Patients in urban Copenhagen (600,000 inhabitants), Denmark, requesting ambulance assistance for acute nontraumatic chest pain were eligible for inclusion from October 27, 2003, to October 31, 2005. Two PCI centers and 4 local hospitals were involved. Patients with STEMI from Copenhagen City were referred to PCI center 1 (maximal transport distance 10 km), whereas those from Copenhagen County were directed to PCI center 2 (maximal transport distance 22 km). All ambulances were manned with
Results
Of 565 included patients, the EMT-basic ambulances enrolled 243 (43%). A total of 184 patients were admitted to a PCI center. Most (n = 168; 91%) were referred directly to PCI based on their prehospital 12-lead ECG, but only 146 of these (87%) underwent emergent catheterization. Sixteen patients (4% of EMT-transported vs 2% of MD-transported; p = 0.1) were referred for PCI after initial triage resulted in admission to the nearest local hospital, where new ECG changes occurred. The remaining 381
Discussion
The present study showed that prehospital 12-lead ECG transmission directly to a cardiologist’s mobile telephone with immediate triage and referral of patients with STEMI directly to a catheterization suite was extremely efficient and for the first time showed door-to-PCI time decreased by >1 hour. More than one third of all ambulances in Europe and the United States carry equipment for recording and transmission of prehospital 12-lead ECGs.1 However, triage delays ensue when attending
Acknowledgment
We appreciate the time and effort put into this study by Falck A/S, Tårnby, Denmark, The Mobile Emergency Care Unit, Copenhagen, Denmark, participating local hospitals, research nurses, attending cardiologists, and PCI operators.
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Cited by (0)
This work was supported by Carl og Katy Kajsings Legat, Copenhagen, Denmark; C.C. Klestrup og hustru Henriette Klestrups Mindelegat, Copenhagen, Denmark; Danske Lægers Forsikring under Codan/SEB Pension, Copenhagen, Denmark; Direktør Emil Hertz og hustru Inger Hertz’ Fond, Copenhagen, Denmark; Eva og Henry Frænkels Mindefond, Copenhagen, Denmark; Købmand Sven Hansen og hustru Ina Hansens Fond, Sorø, Denmark; Lippmann Fonden, Copenhagen, Denmark; and Physio-Control Inc., a division of Medtronic, Redmond, Washington.
Dr. Trautner served on government committees on emergency medicine and prehospital care in Denmark and is medical director of an ambulance service, Falck A/S, Copenhagen, Denmark; Dr. Hampton is a former employee of Physio-Control, Inc., Redmond, Washington, and a current employee of Medtronic, Inc., Redmond, Washington; Dr. Wagner has research grants from Welch Allyn, Beaverton, Oregon, Cierra, Redwood City, California, Boehringer-Ingelheim, Ridgefield, Connecticut, and Medtronic Physio-Control, Inc., Redmond, Washington; and Dr. Clemmensen has research grants from and is a consultant for Medtronic, Inc., Redmond, Washington.