The potential impact of prehospital electrocardiography and telemetry on time to thrombolysis in a United Kingdom center

Abstract

Background: Despite efforts to modify patient attitudes, prehospital, and in-hospital factors, the median symptom-to-needle and door-to-needle time to thrombolysis remains unacceptably long for patients experiencing the symptoms of acute myocardial infarction (AMI) in University Hospital, Nottingham. In order to circumvent avoidable in-hospital delays, we evaluated the use of equipment undergoing field tests with the Nottingham ambulance crew that can record and transmit 12-lead ECGs to the Coronary Care Unit (CCU) from the patient's home, and so enable the identification of patients with AMI who might be appropriate for direct admission to the unit. Methods: From November 1996, for 3 months, ambulance crews recorded ECGs on all patients with chest pain suggestive of AMI. These were transmitted to and assessed by coronary care nursing staff who decided whether they satisfied existing criteria for thrombolysis, and arranged direct admission to CCU. Door-to-needle times were recorded for those patients thrombolysed as a result. Results: One hundred consecutive ECGs were transmitted. Twenty-two showed evidence of AMI resulting in direct admission. Of these, 17 (61%) had a final diagnosis of AMI. Eleven (65%) were eligible for thrombolysis, their median door-to-needle time being reduced by 60 minutes. The remaining 78 patients were taken to the Casualty Department for further assessment Conclusions: ECG 12-lead telemetry could make a significant reduction on chest pain to needle time, reducing delay by at least 1 hour, and has the potential to facilitate out-of-hospital thrombolysis.