Abstract
Background:The use of the 12-lead electrocardiogram (ECG) is common in sophisticated pre-hospital emergency medical services but its value depends upon accurate placement of the ECG electrodes. Several studies have shown widespread variation in the placement of chest electrodes by other health professionals but no studies have addressed the accuracy of paramedics. The main objective of this study was to ascertain the accuracy of the chest lead placements by registered paramedics.Methods:Registered paramedics who attended the Emergency Services Show in Birmingham in September 2018 were invited to participate in this observational study. Participants were asked to place the chest electrodes on a male model in accordance with their current practice. Correct positioning was determined against the Society for Cardiological Science and Technology’s 2017 clinical guidelines for recording a standard 12-lead ECG, with a tolerance of 19 mm being deemed acceptable based upon previous studies.Results:Fifty-two eligible participants completed the study. Measurement of electrode placement in the vertical and horizontal planes showed a high level of inaccuracy, with 3/52 (5.8%) participants able to accurately place all chest electrodes. In leads V1–V3, the majority of incorrect placements were related to vertical displacement, with most participants able to identify the correct horizontal position. In V4, the tendency was to place the electrode too low and to the left of the pre-determined position, while V5 tended to be below the expected positioning but in the correct horizontal alignment. There was a less defined pattern of error in V6, although vertical displacement was more likely than horizontal displacement.Conclusions:Our study identified a high level of variation in the placement of chest ECG electrodes, which could alter the morphology of the ECG. Correct placement of V1 improved placement of other electrodes. Improved initial and refresher training should focus on identification of landmarks and correct placement of V1.
Highlights
P et al Conclusions: Our study identified a high level of variation in the placement of chest ECG electrodes, which could alter the morphology of the ECG
International guidelines for the management of patients presenting with symptoms suggestive of an acute coronary syndrome recommend that a 12-lead electrocardiogram (ECG) be recorded by attending Emergency Medical Service (EMS) personnel prior to hospital conveyance (Garvey et al, 2006; Ibanez et al, 2018; O’Gara et al, 2013; Ting et al, 2008)
Studies have investigated the ability of EMS personnel to interpret 12-lead ECG recordings in cases of ST-elevation myocardial infarction (STEMI) (Cantor et al, 2012; Mencl et al, 2013; O’Donnell et al, 2015; Whitbread et al, 2002), but none have explored the ability of EMS personnel to correctly place the electrodes
Summary
International guidelines for the management of patients presenting with symptoms suggestive of an acute coronary syndrome recommend that a 12-lead electrocardiogram (ECG) be recorded by attending Emergency Medical Service (EMS) personnel prior to hospital conveyance (Garvey et al, 2006; Ibanez et al, 2018; O’Gara et al, 2013; Ting et al, 2008). An older American study (Wenger & Kligfield, 1996) found that leads V1 and V2 were commonly placed superior and lateral of the anatomical location, and that electrodes V4–V6 were commonly placed inferior and lateral of the specified point. From these studies, we hypothesised that there was likely to be a high level of inaccuracy in the placement of the precordial electrodes by EMS personnel. The main objective of this study was to ascertain the accuracy of the chest lead placements by registered paramedics
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