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Impact of field-transmitted electrocardiography on time to in-hospital thrombolytic therapy in acute myocardial infarction

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      Abstract

      To assess the impact of a field-transmitted electrocardiogram (ECG) on patients with possible acute myocardial infarction, randomized and open trials were performed with a portable electrocardiographic system coupled with a cellular phone programmed to automatically transmit ECGs to the base hospital. Consecutive patients served by the 6 units of the Salt Lake City Emergency Rescue System were studied; 71 patients were randomized to in-field ECG (n = 34) versus no ECG (n = 37). Time on scene was 16.4 ± 9.7 minutes for the ECG group versus 16.1 ± 7.0 minutes for the non ECG group (difference not significant). Time of transport averaged 18.2 ± 9.9 and 17.6 ± 13.1 minutes, respectively (difference not significant). Six of 34 patients with in-field ECG showed acute myocardial infarction, qualified for and received thrombolytic therapy at 48 ± 12 minutes after hospital arrival (range 30 to 60) compared with 103 ± 44 minutes (p < 0.01) for 51 historical control patients and 68 ± 29 minutes for 6 concurrent control patients without in-field ECG. Thus, in-field ECG causes negligible delays in paramedic time, leads to significant decreases in time to in-hospital thrombolysis and may make in-field therapy feasible. In-field ECG may be an important addition to reperfusion strategies.
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      References

        • Marder VJ
        • Sherry S
        Thrombolytic therapy: current status.
        N Engl J Med. 1988; 318: 1512-1520
        • Marder VJ
        • Sherry S
        Thrombolytic therapy: current status.
        N Engl J Med. 1988; 318: 1585-1594
        • Anderson JL
        Thrombolytic and other antithrombotic therapies of the acute ischemic syndromes.
        in: Anderson JL Critical Care Cardiology. Karger, New York1988: 15-62
        • DeWood MA
        • Spores J
        • Notske R
        • Mouscr LT
        • Burroughs R
        • Golden MS
        • Lang HT
        Prevalence of total coronary occlusion during the early hours of transmural myocardial infarction.
        N Engl J Med. 1980; 303: 897-902
        • Davis MJ
        • Thomas AC
        Plaque fissuring: the cause of acute myocardial infarction, sudden ischemic death, and crescendo angina.
        Br Heart J. 1985; 53: 363-373
        • Reimer KA
        • Lowe JE
        • Rasmussen MM
        • Jennings RB
        The wavefront phenomenon of ischemic cell death: myocardial infarction size vs. duration of coronary occlusion in drugs.
        Circulation. 1977; 56: 786-794
        • Chesebro JH
        • Knatterud G
        • Roberts R
        • Borer J
        • Cohen LS
        • Dalen J
        • Dodge HT
        • Francis CK
        • Hillis D
        • Ludbrook P
        • Markis JE
        • Mueller H
        • Passamani ER
        • Powers ER
        • Rao AK
        • Robertson T
        • Ross A
        • Ryan TJ
        • Sobel BE
        • Willcrson J
        • Williams DO
        • Zaret BL
        • Braunwald E
        Thrombolysis in Myocardial Infarction (TIMI) Trial, phase IA. Comparison between intravenous plasminogen activator and intravenous streptokinase.
        Circulation. 1987; 76: 142-154
        • Anderson JL
        • Rothbard RL
        • Hackworthy RA
        • Sorensen SG
        • Fitzpatrick PG
        • Dahl CF
        • Hagan AD
        • Browne KF
        • Symkoviak GP
        • Menlove RL
        • Barry WH
        • Eckerson HW
        • Marder VJ
        • The APSAC Multicenter Investigators
        Multicentcr reperfusion trial of intravenous anisoylatcd plasminogen streptokinase activator complex (APSAC) in acute myocardial infarction: controlled comparison with intracoronary streptokinase.
        J Am Coll Cardiol. 1988; 11: 1153-1163
        • Anderson JL
        • Marshall HW
        • Bray BE
        • Lutz JR
        • Frederick PR
        • Yanowitz FG
        • Frederick PD
        • Klausner SC
        • Hagan AD
        A randomized trial of intracoronary streptokinase in the treatment of acute myocardial infarction.
        N Engl J Med. 1983; 308: 1312-1318
        • Spann JF
        • Sherry S
        Coronary thrombolysis for evolving myocardial infarction.
        Drugs. 1984; 28: 465-483
        • Shcehan FH
        • Mathey DG
        • Schofcr J
        • Dodge HT
        • Bolson EL
        Factors that determine recovery of left ventricular function after thrombolysis in patients with acute myocardial infarction.
        Circulation. 1985; 71: 1121-1128
        • Koren G
        • Weiss AT
        • Hasin Y
        • Appelbaum D
        • Welber S
        • Rozeman Y
        • Lotan C
        • Mosseri M
        • Sapoznikov D
        • Luria MH
        • Gotsman MS
        Prevention of myocardial damage in acute myocardial ischemia by early treatment with intravenous streptokinase.
        N Engl J Med. 1985; 313: 1384-1389
        • White HD
        • Norris RM
        • Brown MA
        • Takayama M
        • Maslowski A
        • Bass NM
        • Ormiston JA
        • Whitlock T
        Effect of intravenous streptokinase on left ventricular function and early survival after acute myocardial infarction.
        N Engl J Med. 1987; 317: 850-855
        • O'Rourke M
        • Baron D
        • Keogh A
        • Kelly R
        • Nelson G
        • Barnes C
        • Raftos J
        • Graham K
        • Hillman K
        • Newman H
        • Healey J
        • Woolridge J
        • Rivers J
        • White H
        • Whitlock R
        • Norris R
        Limitation of myocardial infarction by early infusion of recombinant tissue-type plasminogen activator.
        Circulation. 1988; 77: 1311-1315
        • Bassand J-P
        • Machecourt J
        • Cassagnes J
        • Anguenot T
        • Lusson R
        • Borel E
        • Peycelon P
        • Wolf E
        • Ducellier D
        • The APSIM Study Investigators
        Multicenter trial of intravenous anisoylated plasminogen streptokinase activator complex (APSAC) in acute myocardial infarction: effects on infarct size and left ventricular function.
        J Am Coll Cardiol. 1989; 13: 988-997
        • Gruppo Italiano per lo Studio della Streptochinasi nell' Infarcto Miocardico (GISSI)
        Effectiveness of intravenous thrombolytic treatment in acute myocardial infarction.
        Lancet. 1986; 1: 397-401
        • ISIS-2 Collaborative Group
        Randomized trial of intravenous streptokinase, oral aspirin, both, or neither among 17,187 cases of suspected acute myocardial infarction: ISIS-2.
        Lancet. 1988; 2: 349-360
        • Maynard C
        • Althouse R
        • Olsufka M
        • Ritchie JL
        • Davis KB
        • Kennedy JW
        Early versus late hospital arrival for acute myocardial infarction in the Western Washington thrombolytic therapy trials.
        Am J Cardiol. 1989; 63: 1296-1300
        • Kennedy JW
        • Atkins JM
        • Goldstein S
        • Jaffe AS
        • Lambrew CT
        • McIntyre KM
        • Mueller HS
        • Paraskos JA
        • Weaver WD
        Recent changes in management of acute myocardial infarction: implications for emergency care physicians.
        J Am Coll Cardiol. 1988; 11: 446-449
        • Ornato JP
        Role of the emergency department in decreasing the time to thrombolytic therapy in acute myocardial infarction.
        Clin Cardiol. 1990; 13: V-48-V-52
        • Sharkey SW
        • Brunette DD
        • Ruiz E
        • Hession WT
        • Wysham DG
        • Goldcnberg IF
        • Hodges M
        An analysis of time delays preceding thrombolysis for acute myocardial infarction.
        JAMA. 1989; 262: 3171-3174
        • Grim P
        • Feldman T
        • Martin M
        • Donovan R
        • Nevins V
        • Childers RW
        Cellular telephone transmission of 12-lead electrocardiograms from ambulance to hospital.
        Am J Cardiol. 1987; 60: 715-720
        • Kennedy JW
        • Weaver WD
        Potential use of thrombolytic therapy before hospitalizalion.
        Am J Cardiol. 1989; 64: 8A-11A
        • Lee TH
        • Weisberg MC
        • Brand DA
        • Rouan GW
        • Goldman L
        Candidates for thrombolysis among emergency room patients with acute chest pain.
        Ann Intern Med. 1989; 110: 957-962
        • Kudenchuk PJ
        • Ho MT
        • Litwin PE
        • Martin JS
        • Weaver WD
        Accuracy of cardiologist vs. computerized ECG analysis in selecting patients for out-of-hospital thrombolytic therapy (abstr.).
        Circulation. 1989; 80: II-354
        • Blankenship JC
        • Almquist AK
        Cardiovascular complications of thrombolytic therapy in patients with a mistaken diagnosis of acute myocardial infarction.
        J Am Coll Cardiol. 1989; 14: 1579-1582
        • Castaigne AD
        • Herve C
        • Duval-Moulin AM
        • Gaillard M
        • Dubois-Rande JL
        • Boesch C
        • Wolf M
        • Lellouche D
        • Jan F
        • Vernant P
        • Huguenard P
        Prehospital use of APSAC: results of a placebo-controlled study.
        Am J Cardiol. 1989; 64: 30A-33A
        • Neuhaus K-L
        • Feurer W
        • Jeep-Tebbe S
        • Niederer W
        • Vogt A
        • Tcbbe U
        Improved thrombolysis with a modified dose regimen of recombinant tissue-type plasminogen activator.
        J Am Coll Cardiol. 1989; 14: 1566-1569
        • Weaver WD
        • Eisenberg MS
        • Martin JS
        • Litwin PE
        • Shaeffer SM
        • Ho MT
        • Kudenchuk P
        • Hallstrom AP
        • Cerquirra MD
        • Copass MK
        • Kennedy JW
        • Coff LA
        • Ritchie JL
        Myocardial infarction triage and intervention. Project—phase 1: patient characteristics and feasibility of prehospital initiation of thrombolytic therapy.
        J Am Coll Cardiol. 1990; 15: 925-931