Diagnostic performance and potential clinical impact of advanced care paramedic interpretation of ST-segment elevation myocardial infarction in the field
- 1 September 2006
- journal article
- Published by Springer Science and Business Media LLC in CJEM
- Vol. 8 (06), 401-407
- https://doi.org/10.1017/s1481803500014196
Abstract
Objectives:Most studies of pre-hospital management of ST-elevation myocardial infarction (STEMI) have involved physicians accompanying the ambulance crew, or electrocardiogram (ECG) transmission to a physician at the base hospital. We sought to determine if Advanced Care Paramedics (ACPs) could accurately identify STEMI on the pre-hospital ECG and contribute to strategies that shorten time to reperfusion.Methods:A STEMI tool was developed to: 1) measure the accuracy of the ACPs at diagnosing STEMI; and 2) determine the potential time saved if ACPs were to independently administer thrombolytic therapy. Using registry data, we subsequently estimated the time saved by initiating thrombolytic therapy in the field compared with in-hospital administration by a physician.Results:Between August 2003 and July 2004, a correct diagnosis of STEMI on the pre-hospital ECG was confirmed in 63 patients. The performance of the ACPs in identifying STEMI on the ECG resulted in a sensitivity of 95% (95% confidence interval [CI] 86%–99%), a specificity of 96% (95% CI 94%–98%), a positive predictive value (PPV) of 82% (95% CI 71%–90%), and a negative predictive value (NPV) of 99% (95% CI 97%–100%). ACP performance for appropriately using thrombolytic therapy resulted in a sensitivity of 92% (95% CI 78%–98%), a specificity of 97% (95% CI 94%–98%), a PPV of 73% (95% CI 59%–85%) and an NPV of 99% (95% CI 97%–100%). We estimated that the median time saved by ACP administration of thrombolytic therapy would have been 44 minutes.Conclusions:ACPs can be trained to accurately interpret the pre-hospital ECG for the diagnosis of STEMI. These results are important for the design of regional integrated programs aimed at reducing delays to reperfusion.Keywords
This publication has 21 references indexed in Scilit:
- Efficacy and Safety of Tenecteplase in Combination With the Low-Molecular-Weight Heparin Enoxaparin or Unfractionated Heparin in the Prehospital SettingCirculation, 2003
- Safety and feasibility of prehospital thrombolysis carried out by paramedicsBMJ, 2003
- Evaluation of the time saved byprehospital initiation of reteplase forST-elevation myocardial infarction: Results of the early retavase-thrombolysisin myocardial infarction (ER-TIMI) 19 trialJournal of the American College of Cardiology, 2002
- Recognition of ST elevation by paramedicsEmergency Medicine Journal, 2002
- The Prehospital Electrocardiogram in Acute Myocardial Infarction: Is Its Full Potential Being Realized? fn1fn1The National Registry of Myocardial Infarction 2 is supported by Genentech, Inc., South San Francisco, California.Journal of the American College of Cardiology, 1997
- Feasibility, safety, and efficacy of domiciliary thrombolysis by general practitioners: Grampian region early anistreplase trial. GREAT Group.BMJ, 1992
- Prehospital thrombolysis in acute myocardial infarctionThe American Journal of Cardiology, 1990
- The diagnostic impact of prehospital 12-lead electrocardiographyAnnals of Emergency Medicine, 1990
- Prehospital use of APSAC: Results of a placebo-controlled studyThe American Journal of Cardiology, 1989
- Cellular telephone transmission of 12-lead electrocardiograms from ambulance to hospitalThe American Journal of Cardiology, 1987