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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%).
Quinn T et al. Effects of prehospital 12-lead ECG on processes of care and mortality in acute coronary syndrome: A linked cohort study from the Myocardial Ischaemia National Audit Project. Heart 2014 Apr 14; [e-pub ahead of print] (http://dx.doi.org/10.1136/heartjnl-2013-304599)
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).