EKG in ambulance gives heart attack victims an edge

Wednesday, April 06, 2011

There's new evidence why you should call an ambulance if you think you may be having a heart attack.

A new study, presented this week at the American College of Cardiology 2011 Scientific Sessions, shows that heart attack victims who got an electrocardiogram (ECG, or more commonly known as an EKG) in the ambulance before arriving to the hospital had a significantly shorter wait in the Emergency Department (ED) before arriving to the cardiac cath lab for treatment.

The study focused on patients who had a STEMI, a specific type of heart attack caused by a blocked artery leading to decreased blood flow to the heart muscle. Every year about half a million people in the US have a STEMI.

The key to treatment and survival of STEMI patients is to get them to a cath lab where that blocked artery can be opened as quickly as possible.

The study, presented by Dr. James McCabe of the University of California San Francisco, showed that patients who had a prehospital ECG, there was a 44% reduction in the time from when the patient arrived in the ED to the time they got to the cath lab.

There was also a 26% reduction in "door to balloon time," meaning from the time the patient arrived in the ED to the time the blocked artery was opened with a balloon in the cath lab. It was shown that these time reductions were due solely to use of prehospital ECG.

The study was done in San Francisco, where paramedics do not have the ability to transmit ECG's from the ambulance to the ED.

Thus, the impact could be even greater in systems that do have this ability.

Philadelphia Fire Department paramedics also do not have the capability to digitally transfer ECG's to hospitals at this time.

In southern New Jersey, paramedics can transmit ECG's from their ambulances to many hospitals, such as Cooper University Hospital, Underwood Hospital, and the Virtua healthcare system.

In the southern NJ system, when a paramedic suspects the patient is having a STEMI, the patient is taken to a hospital with a cath lab, and during the trip, an ECG is transmitted directly to the receiving hospital.

The system, called LifeNet, also automatically forwards the ECG to the smart phone of an interventional cardiologist at that hospital.

"This all means that essential time is saved by enabling the ED and the cath lab staff to make decisions about the patient prior to their arrival," stated Scott Kasper, Corporate Director of Emergency Services at Virtua Hospital.

Dr. Rick Hong, head of the Division of EMS/Disaster Medicine at Cooper University Hospital believes the LifeNet system has been beneficial in improving collaboration between the ED and Cardiology teams.

"There have been situations in which the cardiology team arrived to the Emergency Department prior to the patient's arrival to escort the patient to the cath lab," said Hong. Although specific data isn't in yet at Cooper, the Emergency Department has anecdotally seen a significant impact on door-to-balloon times with the use of LifeNet.

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