PMID- 29708085 OWN - NLM STAT- MEDLINE DCOM- 20181030 LR - 20181030 IS - 1945-1938 (Electronic) IS - 1049-023X (Linking) VI - 33 IP - 3 DP - 2018 Jun TI - Weekly Checks Improve Real-Time Prehospital ECG Transmission in Suspected STEMI. PG - 245-249 LID - 10.1017/S1049023X18000341 [doi] AB - IntroductionField identification of ST-elevation myocardial infarction (STEMI) and advanced hospital notification decreases first-medical-contact-to-balloon (FMC2B) time. A recent study in this system found that electrocardiogram (ECG) transmission following a STEMI alert was frequently unsuccessful.HypothesisInstituting weekly test ECG transmissions from paramedic units to the hospital would increase successful transmission of ECGs and decrease FMC2B and door-to-balloon (D2B) times. METHODS: This was a natural experiment of consecutive patients with field-identified STEMI transported to a single percutaneous coronary intervention (PCI)-capable hospital in a regional STEMI system before and after implementation of scheduled test ECG transmissions. In November 2014, paramedic units began weekly test transmissions. The mobile intensive care nurse (MICN) confirmed the transmission, or if not received, contacted the paramedic unit and the department's nurse educator to identify and resolve the problem. Per system-wide protocol, paramedics transmit all ECGs with interpretation of STEMI. Receiving hospitals submit patient data to a single registry as part of ongoing system quality improvement. The frequency of successful ECG transmission and time to intervention (FMC2B and D2B times) in the 18 months following implementation was compared to the 10 months prior. Post-implementation, the time the ECG transmission was received was also collected to determine the transmission gap time (time from ECG acquisition to ECG transmission received) and the advanced notification time (time from ECG transmission received to patient arrival). RESULTS: There were 388 patients with field ECG interpretations of STEMI, 131 pre-intervention and 257 post-intervention. The frequency of successful transmission post-intervention was 73% compared to 64% prior; risk difference (RD)=9%; 95% CI, 1-18%. In the post-intervention period, the median FMC2B time was 79 minutes (inter-quartile range [IQR]=68-102) versus 86 minutes (IQR=71-108) pre-intervention (P=.3) and the median D2B time was 59 minutes (IQR=44-74) versus 60 minutes (IQR=53-88) pre-intervention (P=.2). The median transmission gap was three minutes (IQR=1-8) and median advanced notification time was 16 minutes (IQR=10-25). CONCLUSION: Implementation of weekly test ECG transmissions was associated with improvement in successful real-time transmissions from field to hospital, which provided a median advanced notification time of 16 minutes, but no decrease in FMC2B or D2B times. D'ArcyNT, BossonN, KajiAH, BuiQT, FrenchWJ, ThomasJL, ElizarrarazY, GonzalezN, GarciaJ, NiemannJT. Weekly checks improve real-time prehospital ECG transmission in suspected STEMI. Prehosp Disaster Med. 2018;33(3):245-249. FAU - D'Arcy, Nicole T AU - D'Arcy NT AD - 1Harbor-UCLA Medical Center and Los Angeles Biomedical Institute,Torrance,California USA;David Geffen School of Medicine at UCLA,Los Angeles,CaliforniaUSA. FAU - Bosson, Nichole AU - Bosson N AD - 1Harbor-UCLA Medical Center and Los Angeles Biomedical Institute,Torrance,California USA;David Geffen School of Medicine at UCLA,Los Angeles,CaliforniaUSA. FAU - Kaji, Amy H AU - Kaji AH AD - 1Harbor-UCLA Medical Center and Los Angeles Biomedical Institute,Torrance,California USA;David Geffen School of Medicine at UCLA,Los Angeles,CaliforniaUSA. FAU - Bui, Quang T AU - Bui QT AD - 1Harbor-UCLA Medical Center and Los Angeles Biomedical Institute,Torrance,California USA;David Geffen School of Medicine at UCLA,Los Angeles,CaliforniaUSA. FAU - French, William J AU - French WJ AD - 1Harbor-UCLA Medical Center and Los Angeles Biomedical Institute,Torrance,California USA;David Geffen School of Medicine at UCLA,Los Angeles,CaliforniaUSA. FAU - Thomas, Joseph L AU - Thomas JL AD - 1Harbor-UCLA Medical Center and Los Angeles Biomedical Institute,Torrance,California USA;David Geffen School of Medicine at UCLA,Los Angeles,CaliforniaUSA. FAU - Elizarraraz, Yvonne AU - Elizarraraz Y AD - 1Harbor-UCLA Medical Center and Los Angeles Biomedical Institute,Torrance,California USA;David Geffen School of Medicine at UCLA,Los Angeles,CaliforniaUSA. FAU - Gonzalez, Natalia AU - Gonzalez N AD - 1Harbor-UCLA Medical Center and Los Angeles Biomedical Institute,Torrance,California USA;David Geffen School of Medicine at UCLA,Los Angeles,CaliforniaUSA. FAU - Garcia, Jose AU - Garcia J AD - 1Harbor-UCLA Medical Center and Los Angeles Biomedical Institute,Torrance,California USA;David Geffen School of Medicine at UCLA,Los Angeles,CaliforniaUSA. FAU - Niemann, James T AU - Niemann JT AD - 1Harbor-UCLA Medical Center and Los Angeles Biomedical Institute,Torrance,California USA;David Geffen School of Medicine at UCLA,Los Angeles,CaliforniaUSA. LA - eng PT - Journal Article PT - Observational Study DEP - 20180430 PL - United States TA - Prehosp Disaster Med JT - Prehospital and disaster medicine JID - 8918173 MH - Aged MH - Electrocardiography/*standards MH - *Emergency Medical Services MH - Female MH - Humans MH - Los Angeles MH - Male MH - Middle Aged MH - Myocardial Infarction MH - Quality Improvement/*organization & administration MH - Retrospective Studies MH - *ST Elevation Myocardial Infarction MH - Time Factors OTO - NOTNLM OT - D2B door-to-balloon OT - ECG electrocardiogram OT - EMS Emergency Medical Services OT - FMC2B first-medical-contact-to-balloon OT - LA Los Angeles OT - Los Angeles OT - MICN mobile intensive care nurse OT - PCI percutaneous coronary intervention OT - SRC STEMI Receiving Center OT - STEMI ST-elevation myocardial infarction OT - UCLA University of California OT - ECG transmission OT - Emergency Medical Services OT - STEMI OT - electrocardiography EDAT- 2018/05/01 06:00 MHDA- 2018/10/31 06:00 CRDT- 2018/05/01 06:00 PHST- 2018/05/01 06:00 [pubmed] PHST- 2018/10/31 06:00 [medline] PHST- 2018/05/01 06:00 [entrez] AID - S1049023X18000341 [pii] AID - 10.1017/S1049023X18000341 [doi] PST - ppublish SO - Prehosp Disaster Med. 2018 Jun;33(3):245-249. doi: 10.1017/S1049023X18000341. Epub 2018 Apr 30.