Does cardiac catheterization laboratory activation by electrocardiography machine auto-interpretation reduce door-to-balloon time?

Introduction In patients with acute ST elevation myocardial ischemia (STEMI), national efforts have focused on reducing door-to-balloon (D2B) times for primary percutaneous coronary intervention (PCI). This emphasis on time-to-treatment may increase the rate of inappropriate cardiac catheterization laboratory (CCL) activations and unnecessary healthcare utilization. To achieve lower D2B times, community hospitals and EMS systems have enabled emergency medical technicians (EMTs) and emergency department (ED) physicians to activate the CCLs without immediately consulting a cardiologist. Objective The purpose of this study is to determine the rate and main causes of inappropriate activation of the CCL which will aid in finding solutions to reduce this occurrence. Method This is a retrospective study, based on an electronic medical system review of all inappropriate CCL activation who presented to Providence Hospital and Medical Centers (PHMC) in Michigan, from January 2015 to July 2016. Results The CCL was activated 375 times for suspected STEMI. The false STEMI activation was identified in 47 patients which represents 12.5% of total CCL activation. The vast majority of this false activation was due to non-diagnostic electrocardiogram (ECG) that did not meet the STEMI criteria. Conclusion The subjective interpretation of the ECG by EMTs and ED physicians tend to show a wide variability, which may lead to higher-than-anticipated false activation rates of up to 36% in one study. Some studies had reported that up to 72% of inappropriate activations were caused by ECG misinterpretations. These false activations have ramifications that lead to both clinical and financial costs.

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Abstract 2405: Effect of Early Emergency Room Notification on Door-to-Balloon Time in Patients Presenting with ST Elevation Myocardial Infarction

Circulation ◽

10.1161/circ.116.suppl_16.ii_528-a ◽

2007 ◽

Vol 116 (suppl_16) ◽

Author(s):

Youssef Kardouh ◽

Anjani Rao ◽

Kimberly Green ◽

Joselyn Ymana ◽

Shukri David

Keyword(s):

Myocardial Infarction ◽

Emergency Room ◽

Cardiac Catheterization ◽

Reperfusion Therapy ◽

The United States ◽

Initial Assessment ◽

Aggressive Approach ◽

Catheterization Laboratory ◽

Cardiac Catheterization Laboratory ◽

Door To Balloon

Background: The goal of mechanical reperfusion therapy in the setting of ST Segment Elevation Myocardial Infarction (STEMI) is to re-establish blood flow to the affected vascular bed as quickly as possible. Primary angioplasty has been shown to be superior to fibrinolysis when door-to-balloon (DTB) time is less than 60 minutes. The median DTB time in the United States is 185 minutes and only 3% of patients are currently being mechanically reperfused within the 90 minutes as recommended by American College of Cardiology guidelines. The purpose of this study is to see if an aggressive approach involving emergency medical services (EMS), emergency room (ER) personnel, and the early activation of cardiac interventional team could improve reperfusion times. We evaluated the feasibility of pre-hospital Electrocardiogram (phECG) to triage patients with STEMI directly to the cardiac catheterization laboratory (CCL) compared to the standard therapy at two primary PCI centers Methods: The EMS personnel obtained a 12-lead ECG during initial assessment in the field from patients with symptoms of myocardial infarction. The ECG was immediately transmitted to the ER physician by cellular link to a computer receiving station located in the ER. The ER physician reviewed the 12-lead ECG digital tracing. The cardiac catheterization laboratory (CCL) team was activated from the patients’ homes. Patients were transported from the field directly to the CCL by EMS bypassing ER admission. Results: From Oct 2003 to May 2007, 142 consecutive patients with STEMI who presented to Providence Hospital and Medical Centers were included in the study. The conventional treatment group (125 patients) had a mean DTB time of 123 minutes. We identified 359 phECGs transmitted to the ER, 43 of which had inadequate transmission signal. Adequate phECG transmission was detected in 88% cases. We diagnosed 17 patients with STEMI by phECG who were included for the analysis. The mean DTB time was significantly lower in patients diagnosed using phECG (46 minutes vs. 123 minutes, p<0.001). Conclusion: Utilizing the phECG as a tool to bypass ER triage significantly decreases DTB times in patients with STEMI. This technology has the potential to substantially expedite reperfusion therapy in patients with STEMI.

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