Novel electrocardiogram configurations and transmission procedures in the prehospital setting: effect on ischemia and arrhythmia determination

Abstract

Aim The aims of this report are to (1) describe a novel prehospital 12-lead electrocardiogram (ECG) configuration and transmission procedure used in the Synthesized Twelve-lead ST Monitoring and Real-time Tele-electrocardiography Study and to (2) report on the frequency of arrhythmias in field ECGs compared with the first hospital ECG. Methods The Synthesized Twelve-lead ST Monitoring and Real-time Tele-electrocardiography Study is a 5-year randomized clinical trial ending in 2008. All emergency vehicles responding to 911 calls in Santa Cruz County, Calif, have been equipped with portable monitor defibrillators with a special study software that (1) synthesizes a 12-lead ECG from 5 electrodes, (2) measures ST amplitudes in all 12 leads every 30 seconds, and (3) automatically transmits an ECG to the target emergency department if there is a change in ST amplitude of 200 μV in 1 lead or more or 100 μV in 2 contiguous leads or more lasting 2.5 minutes. An initial ECG is transmitted by paramedics, which activates the software. Subsequent transmissions of ST event ECGs occur automatically without paramedic decision making. Results Prehospital ECGs had a greater frequency of arrhythmias than the first hospital ECG in the group as a whole (n = 433; 33.3% vs 28.9%; P ≤ .001), as well as the subgroup with acute coronary syndrome (n = 185; 30.3% vs 26.5%; P ≤ .001). More tachyarrhythmias occurred in the field and slightly more bradyarrhythmias occurred at the time of the first hospital ECG. Conclusions Prehospital continuous 12-lead ST-segment ischemia monitoring with computer-assisted automatic mobile telephone transmission of ST event ECGs to the target hospital is feasible. More arrhythmias occur in the prehospital phase than are evident on the first hospital ECG.