Korean Circ J.  2020 Aug;50(8):709-719. 10.4070/kcj.2019.0337.

Community-Based Pre-HospitalElectrocardiogram TransmissionProgram for Reducing Systemic TimeDelay in Acute ST-Segment ElevationMyocardial Infarction

• Park K
• Park JS
• Cho YR
• Park TH
• Kim MH
• Yang TH
• Kim DI
• Kim JH
• Lee YH
• Lee DW
• Seo J
• Lee GY
• Kim YD

• KMID: 2505125
• DOI: http://doi.org/10.4070/kcj.2019.0337

Abstract

Background and Objectives
In acute ST-segment elevation myocardial infarction (STEMI),on-site transmission of electrocardiogram (ECG) has been shown to reduce systemic timedelay to reperfusion and improve outcomes. However, it has not been adopted in communitybasedemergency transport system in Korea.
Methods
Busan Regional Cardio-cerebrovascular Center and Busan Metropolitan City Fireand Safety Headquarters (BMFSH) jointly developed and conducted a pre-hospital ECGtransmission program. Seven tertiary hospitals and 22 safety stations of BMFSH participated.Systemic time delay to reperfusion of STEMI patients in the program was compared with thatof 95 patients transported by 119 emergency medical system (EMS) before the program wasimplemented.
Results
During the study period, 289 ECG transmissions were made by 119 EMS personnel,executed within 5 minutes in 88.1% of cases. Of these, 42 ECGs were interpreted as STsegmentelevation. Final diagnosis of STEMI was made in 20 patients who underwent primarypercutaneous coronary intervention. With the program, systemic time delay to reperfusion wassignificantly reduced (median [interquartile range; IQR], 76.0 [62.2–98.7] vs. 90.0 [75.0–112.0],p<0.01). Significant reduction of door-to-balloon time was also observed (median [IQR], 45.0[34.0–69.5] vs. 58.0 [51.0–68.0], p=0.03). The proportion of patients with systemic time delayshorter than 90 minutes rose (51.6% vs. 75.0%, p=0.08) with pre-hospital ECG transmission.
Conclusions
We developed and implemented a community-based pre-hospital ECG transmission program for expeditious triage of STEMI patients. Significant reductions ofsystemic time delay and door-to-balloon time were observed. The expanded use of prehospitalECG transmission should be encouraged to realize the full potential of this program.

Keyword

ST elevation myocardial infarction; Percutaneous coronary intervention; Triage

Figure

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  Figure 1 Location of 22 stations of BMFSH and 7 primary PCI-performing hospitals (6 regional hospitals and Busan Regional Cardio-Cerebrovascular Center), participating in the pre-hospital ECG transmission program.BMFSH = Busan Metropolitan City Fire and Safety Headquarters; ECG = electrocardiogram; PCI = percutaneous coronary intervention.

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  Figure 2 Box plots showing median levels of the time delay to reperfusion of the patients in the study group compared with the control group. (A) shows FMC-B time between the study and control groups, and (B) shows D-B time. Boxes show interquartile ranges.D-B = door to balloon; FMC-B = first medical contact to balloon.

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  Figure 3 Proportion of patients with FMC-B time less than 90 minutes (A), and proportion of patients with D-B time less than 60 minutes (B).D-B = door to balloon; FMC-B = first medical contact to balloon.

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