Pre-Hospital Electrocardiography by Emergency Medical Personnel: Effects on Scene and Transport Times for Chest Pain and ST-Segment Elevation Myocardial Infarction Patients

Study Questions:

What is the impact of prehospital electrocardiography (ECG) on scene-to-hospital time for patients with chest pain of cardiac origin and those with ST-segment elevation myocardial infarction (STEMI)?

Methods:

The authors analyzed the City of San Diego Emergency Medical System runsheets of patients with chest pain from January 2003 to April 2008. The scene times and transport times were compared before and after implementation of the prehospital ECG. Among patients with a prehospital ECG, median scene times and transport times were compared in patients with and without STEMI.

Results:

A total of 21,742 patients were evaluated for chest pain during the study period. Patients treated after implementation of prehospital ECG had a statistically significant, but clinically unimportant increase in median scene time (19 minutes [min], 10 seconds [s] vs. 19 min, 28 s; p = 0.002) and transport time (13 min, 16 s vs. 13 min, 28 s; p = 0.007). In patients with STEMI (n = 303), prehospital ECG was associated with shorter median scene time (17 min, 51 s vs. 19 min, 31 s; p < 0.001), transport time (12 min, 34 s vs. 13 min, 31 s; p = 0.006), and scene-to-hospital time (30 min, 45 s vs. 33 min, 29 s; p = 0.001).

Conclusions:

The authors concluded that obtaining a prehospital ECG for patients with chest pain is not associated with clinically important prolongation of scene and transport time.

Perspective:

Prehospital ECGs are highly effective in reducing time to reperfusion in patients with STEMI. This study demonstrates that prehospital ECG can be routinely obtained in all patients with chest pain without any meaningful delay in transport time. This large well-done study should allay any concerns about potential delays in association with routine use of this strategy, and should encourage its wider adoption.

Clinical Topics: Invasive Cardiovascular Angiography and Intervention

Keywords: Myocardial Infarction, Emergency Medical Services, Chest Pain, Cardiology, Electrocardiography, Angioplasty


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