Abstract
Introduction: Early recognition and rapid revascularization is associated with improved outcomes in patients with STEMI. Increasingly, prehospital emergency medical services (EMS) providers acquire prehospital ECGs, transport patients to PCI-ready hospitals, and activate interventional cardiology teams in advance of hospital arrival (“door time”). Therefore, the time from first medical contact (FMC) with either EMS providers or the emergency department may be an important metric for overall system performance in the care of patients with STEMI. Hypothesis: A prehospital ECG transmission program will be associated with a decreased median FMC to revascularization device deployment (“device”) time. Methods: A retrospective cohort study of Action Registry-GWTG data in Chicago was performed. The Chicago Fire Department implemented a 12-lead ECG transmission program in 2012. Patients with confirmed STEMI from January through December 2013 were included. A baseline median FMC to device time was determined for the third quarter of 2012, at the start of the ECG transmission program. Descriptive statistics were used for analysis. Results: Over the study period, 352 patients experiencing STEMI were treated in 9 hospitals. Patients were predominantly male (66%), and 50% arrived by ambulance. The average median FMC to device time over the study period was 83 minutes, which was decreased from a baseline of 104 minutes. The median time from FMC to door and median time from catheterization laboratory arrival to device remained constant over the study period (24 minutes and 22 minutes respectively), but the median time from door to catheterization laboratory decreased from 42 minutes to 33 minutes. Conclusions: Implementation of a prehospital ECG transmission program was associated with a decreased median FMC to device time in a large urban city, with FMC to device times consistently less than 90 minutes. The median door to device time for all patients regardless of arrival mode decreased over implementation, suggesting improved care processes for all patients with STEMI.
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