Abstract 1290: Impact on Door-to-Balloon Time of Integrating Prehospital Electrocardiograms Into Systems of Care: The Mayo Clinic Prehospital Electrocardiogram Program
Background: Use of prehospital electrocardiograms (PH ECG) can decrease door-to-balloon (DTB) time for patients with ST-elevation myocardial infarction (STEMI), but remains under-utilized for acute coronary syndromes (ACS).
Methods: The Mayo Clinic PH ECG program was implemented during 9/2007 in Olmsted County (population 141,360) with Gold Cross Emergency Medical Services (GC EMS). During the pre-phase (6/1/2006–8/31/2007) and post-phase (10/1/2007–2/28/2009), 855 and 1122 consecutive patients, respectively, with ACS were transported by GC EMS. During pre-phase, there was no PH ECG protocol. During post-phase, PH ECG was diagnosed Definite STEMI when computer and paramedic had concordant interpretation of new ST-elevation; Possible STEMI when computer and paramedic had discordant interpretation; and Not STEMI. Patients with Definite STEMI had prehospital activation of the catheterization lab and bypassed emergency department. During pre- and post-phases, there were 135 and 118 STEMI patients, respectively, admitted to Saint Marys Hospital, Rochester, Minnesota and categorized into transported by GC EMS, other EMS services, and self-transported.
Results: PH ECG use increased from 45% to 78% patients comparing pre- versus post-phase (p<0.001). In the pre-phase, patients transported by GC EMS (n=52), by other EMS services (n=23), and self transported (n=60) had median DTB 61, 62, and 76 minutes, respectively (p=0.044). In the post-phase, patients (n=26) diagnosed with Definite STEMI had median DTB 32 minutes which was significantly better than those diagnosed with Possible or Not STEMI (n=28), transported by other EMS service (n=14), and self transported (n=50) with median DTB 67, 66, and 61 minutes respectively (p<0.001). Overall median DTB was 65 and 61 minutes during the pre- and post-phase, respectively (p=0.37).
Conclusions: Median DTB was decreased to 32 minutes for patients diagnosed with Definite STEMI on PH ECG. Future work will focus on increasing the sensitivity of paramedic diagnosis of Definite STEMI on PH ECG in order to impact a larger percentage of STEMI patients.