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Does a Prehospital Electrocardiogram Improve Myocardial Infarction Care?

April 14, 2014

Does a Prehospital Electrocardiogram Improve Myocardial Infarction Care?

  1. Daniel J. Pallin, MD, MPH

An observational study in England and Wales correlates obtaining a prehospital ECG with better care and outcomes.

  1. Daniel J. Pallin, MD, MPH

Most emergency medical services (EMS) systems can perform prehospital electrocardiograms (ECGs), and some can even bypass the emergency department to transport patients straight to the catheterization lab. However, debate continues about whether specific prehospital interventions actually improve patient care or outcomes. Investigators reviewed a national myocardial infarction (MI) registry in England and Wales to determine whether obtaining a prehospital ECG was associated with better processes of care and patient outcomes.

Of 288,990 MI patients transported to the hospital by EMS between 2005 and 2009, 50% received prehospital ECGs, and 32% did not (ECG status was unknown for 18%). Among patients with ST segment elevation myocardial infarction, those with a prehospital ECG were more likely than those without to undergo reperfusion (84% vs. 74%), have a call-to-balloon time <90 minutes (28% vs. 21%), and have an arrival-to-fibrinolysis time <30 minutes (91% vs. 84%). Overall, 30-day mortality was lower in patients with a prehospital ECG (7.4% vs. 8.2%).

Comment

There may be reasons why some patients received prehospital electrocardiograms and others did not: The ones who did not may have been sicker or may have had more obscure presentations. Although this study is flawed by its design, its findings are consistent with those of other studies showing that obtaining a prehospital ECG shortens time to treatment and improves care (NEJM JW Emerg Med Apr 5 2013, NEJM JW Emerg Med Oct 17 2008).

  • Disclosures for Daniel J. Pallin, MD, MPH at time of publication Grant / research support Agency for Healthcare Research and Quality; Department of Defense; Massachusetts Coalition for the Prevention of Medical Errors; NIH

Citation(s):

Reader Comments (2)

Brendan Carmody M.D. Physician, Emergency Medicine, Suburban Hospital

The biggest value aside from faster care is the decreased resource utilization. A pre-hospital EKG lessens the frequency of false activations of the cath lab team.

Robert Dunn MBBS FACEM Physician, Emergency Medicine

As only patients with a discharge diagnosis of ACS were included, this study cannot evaluate the potentially harmful effects of false positive ECGs in the presumably millions of prehospital ECGs taken. Also, the baseline rates of STEMI were markedly different in the ECG vs no ECG groups, almost certainly indicating significant bias in the selection of cases to receive perform ECG. No valid conclusions can be reached regarding the usefulness of the prehospital ECG in this non randomised, selection biased study that excludes the majority of the population of interest (i.e. all patients who activate EMS with possible myocardial ischaemia).

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