Pre-hospital 12-lead electrocardiography programs: a call for implementation by emergency medical services systems providing advanced life support--National Heart Attack Alert Program (NHAAP) Coordinating Committee; National Heart, Lung, and Blood Institute (NHLBI); National Institutes of Health.

Emergency medical services (EMS) providers who administer advanced life support should include diagnostic 12-lead electrocardiography programs as one of their services. Evidence demonstrates that this technology can be readily used by EMS providers to identify patients with ST-segment elevation myocardial infarction (STEMI) before a patient's arrival at a hospital emergency department. Earlier identification of STEMI patients leads to faster artery-opening treatment with fibrinolytic agents, either in the pre-hospital setting or at the hospital. Alternatively, a reperfusion strategy using percutaneous coronary intervention can be facilitated by use of pre-hospital 12-lead electrocardiography (P12ECG). Analysis of the cost of providing this service to the community must include consideration of the demonstrated benefits of more rapid treatment of patients with STEMI and the resulting time savings advantage shown to accompany the use of P12ECG programs.

[1]  Johan Herlitz,et al.  Indications for fibrinolytic therapy in suspected acute myocardial infarction : collaborative overview of early mortality and major morbidity results from all randomised trials of more than 1000 patients , 1994 .

[2]  A. Davie.  Early thrombolytic treatment in acute myocardial infarction , 1996, The Lancet.

[3]  T. Aufderheide,et al.  Test of the acute cardiac ischemia time-insensitive predictive instrument (ACI-TIPI) for prehospital use. , 1996, Annals of emergency medicine.

[4]  G. Casolo,et al.  Evaluation of a mobile coronary care unit protocol in patients with acute onset chest pain. , 1991, The Journal of emergency medicine.

[5]  Eric Boersma,et al.  Early thrombolytic treatment in acute myocardial infarction: reappraisal of the golden hour , 1996, The Lancet.

[6]  J S Martin,et al.  Utility of the prehospital electrocardiogram in diagnosing acute coronary syndromes: the Myocardial Infarction Triage and Intervention (MITI) Project. , 1998, Journal of the American College of Cardiology.

[7]  J. Ornato,et al.  Prehospital management of acute ST-elevation myocardial infarction: a time for reappraisal in North America. , 2003, American heart journal.

[8]  J. Ioannidis,et al.  Diagnosing acute cardiac ischemia in the emergency department: a systematic review of the accuracy and clinical effect of current technologies. , 2001, Annals of emergency medicine.

[9]  Dave Williams,et al.  2004 JEMS 200-city survey. , 2005, JEMS : a journal of emergency medical services.

[10]  C. Fry,et al.  Science of urinary incontinence Report of a Meeting of Physicians and Scientists, University College London , 1994, The Lancet.

[11]  A. Adgey,et al.  The initial electrocardiogram in patients seen by a mobile coronary care unit. , 1991, The Quarterly journal of medicine.

[12]  M. Hand.  "Act in Time to Heart Attack Signs" action plan: a patient-based critical pathway. , 2002, Critical pathways in cardiology.

[13]  P. Armstrong,et al.  Fibrinolysis for acute myocardial infarction: current status and new horizons for pharmacological reperfusion, part 1. , 2001, Circulation.

[14]  E. Antman,et al.  Fibrinolysis for acute myocardial infarction: the future is here and now. , 2003, Circulation.

[15]  W. Rogers,et al.  Temporal trends in the treatment of over 1.5 million patients with myocardial infarction in the US from 1990 through 1999: the National Registry of Myocardial Infarction 1, 2 and 3. , 2000, Journal of the American College of Cardiology.

[16]  P. Kudenchuk,et al.  Prehospital-initiated vs hospital-initiated thrombolytic therapy. The Myocardial Infarction Triage and Intervention Trial. , 1993, JAMA.

[17]  W. Weaver,et al.  Factors influencing the time to thrombolysis in acute myocardial infarction. Time to Thrombolysis Substudy of the National Registry of Myocardial Infarction-1. , 1997, Archives of internal medicine.

[18]  W. Weaver,et al.  Factors influencing the time to thrombolysis in acute myocardial infarction. Time to Thrombolysis Substudy of the National Registry of Myocardial Infarction-1. , 1997, Archives of internal medicine.

[19]  G. Lamas,et al.  ACC/AHA guidelines for the management of patients with ST-elevation myocardial infarction--executive summary. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to revise the 1999 guidelines for the management of patients wi , 2004, Journal of the American College of Cardiology.

[20]  J. Gurwitz,et al.  Duration of, and temporal trends (1994-1997) in, prehospital delay in patients with acute myocardial infarction: the second National Registry of Myocardial Infarction. , 1999, Archives of internal medicine.

[21]  T. Aufderheide,et al.  The diagnostic impact of prehospital 12-lead electrocardiography. , 1989, Annals of emergency medicine.

[22]  E. Topol,et al.  Regionalization of care for acute ischemic heart disease: a call for specialized centers. , 2003, Circulation.

[23]  M. Hand.  Act in time to heart attack signs: update on the National Heart Attack Alert Program's campaign to reduce patient delay. , 2004, Critical pathways in cardiology.

[24]  Adam Brown,et al.  Demographic, belief, and situational factors influencing the decision to utilize emergency medical services among chest pain patients. Rapid Early Action for Coronary Treatment (REACT) study. , 2000, Circulation.

[25]  C. Terkelsen,et al.  Telemedicine used for remote prehospital diagnosing in patients suspected of acute myocardial infarction , 2002, Journal of internal medicine.

[26]  J. Griffith,et al.  Use of the Electrocardiograph-Based Thrombolytic Predictive Instrument To Assist Thrombolytic and Reperfusion Therapy for Acute Myocardial Infarction: A Multicenter, Randomized, Controlled, Clinical Effectiveness Trial , 2002, Annals of Internal Medicine.

[27]  J. Lowe,et al.  The Wavefront Phenomenon of Ischemic Cell Death: 1. Myocardial Infarct Size vs Duration of Coronary Occlusion in Dogs , 1977, Circulation.

[28]  William J. Rogers,et al.  Use of Emergency Medical Services in Acute Myocardial Infarction and Subsequent Quality of Care: Observations From the National Registry of Myocardial Infarction 2 , 2002, Circulation.

[29]  W. Weaver,et al.  The prehospital electrocardiogram in acute myocardial infarction: is its full potential being realized? National Registry of Myocardial Infarction 2 Investigators. , 1997, Journal of the American College of Cardiology.

[30]  T. Aufderheide,et al.  Milwaukee Prehospital Chest Pain Project--phase I: feasibility and accuracy of prehospital thrombolytic candidate selection. , 1992, The American journal of cardiology.

[31]  R. Califf,et al.  At home thrombolysis. , 1990, Journal of the American College of Cardiology.

[32]  J. L. Brown,et al.  An eight-month evaluation of prehospital 12-lead electrocardiogram monitoring in Baltimore County. , 1997, Maryland medical journal.

[33]  David Brieger,et al.  Extent of, and factors associated with, delay to hospital presentation in patients with acute coronary disease (the GRACE registry). , 2002, The American journal of cardiology.

[34]  H A Feldman,et al.  Effect of a community intervention on patient delay and emergency medical service use in acute coronary heart disease: The Rapid Early Action for Coronary Treatment (REACT) Trial. , 2000, JAMA.

[35]  S. Osganian,et al.  Prehospital delay in patients hospitalized with heart attack symptoms in the United States: the REACT trial. Rapid Early Action for Coronary Treatment (REACT) Study Group. , 1999, American heart journal.

[36]  J. Willerson,et al.  Editor's commentary: centers of excellence. , 2003, Circulation.

[37]  H. Krumholz,et al.  Regionalization of care for acute coronary syndromes: more evidence is needed. , 2005, JAMA.

[38]  J. Anderson,et al.  Impact of field-transmitted electrocardiography on time to in-hospital thrombolytic therapy in acute myocardial infarction. , 1990, The American journal of cardiology.

[39]  T. Aufderheide,et al.  Evaluation of ST segment elevation criteria for the prehospital electrocardiographic diagnosis fo acute myocardial infarction. , 1994, Annals of emergency medicine.

[40]  J S Martin,et al.  Accuracy of computer-interpreted electrocardiography in selecting patients for thrombolytic therapy. MITI Project Investigators. , 1991, Journal of the American College of Cardiology.

[41]  M. Sayre,et al.  P REHOSPITAL T RIAGE OF C HEST P AIN P ATIENTS , 2002, Prehospital emergency care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors.

[42]  M. Eisenberg,et al.  Causes of delay in seeking treatment for heart attack symptoms. , 1995, Social science & medicine.

[43]  L. Morrison,et al.  Mortality and prehospital thrombolysis for acute myocardial infarction: A meta-analysis. , 2000, JAMA.

[44]  Paula Finn,et al.  American Heart Association--scientific sessions 2005. 13-16 November 2005, Dallas, TX, USA. , 2006, IDrugs : the investigational drugs journal.

[45]  N Clay Mann,et al.  Association between prepayment systems and emergency medical services use among patients with acute chest discomfort syndrome. , 2000, Annals of emergency medicine.

[46]  J. Herlitz,et al.  Prehospital identification of acute coronary syndrome/myocardial infarction in relation to ST elevation. , 2005, International journal of cardiology.

[47]  D. Foster,et al.  Prehospital recognition of AMI using independent nurse/paramedic 12-lead ECG evaluation: impact on in-hospital times to thrombolysis in a rural community hospital. , 1994, The American journal of emergency medicine.

[48]  E. Bedrick,et al.  The prehospital 12-lead electrocardiogram's effect on time to initiation of reperfusion therapy: a systematic review and meta-analysis of existing literature. , 2005, The American journal of emergency medicine.

[49]  R. Califf,et al.  Persistence of delays in presentation and treatment for patients with acute myocardial infarction: The GUSTO-I and GUSTO-III experience. , 2002, Annals of emergency medicine.

[50]  W. Gibler,et al.  Relative importance of emergency medical system transport and the prehospital electrocardiogram on reducing hospital time delay to therapy for acute myocardial infarction: a preliminary report from the Cincinnati Heart Project. , 1992, American heart journal.

[51]  B. Nallamothu,et al.  Percutaneous coronary intervention versus fibrinolytic therapy in acute myocardial infarction: is timing (almost) everything? , 2003, The American journal of cardiology.

[52]  Á. Avezum,et al.  Practice variation and missed opportunities for reperfusion in ST-segment-elevation myocardial infarction: findings from the Global Registry of Acute Coronary Events (GRACE) , 2002, The Lancet.

[53]  Elliott M. Antman,et al.  Time Delay to Treatment and Mortality in Primary Angioplasty for Acute Myocardial Infarction: Every Minute of Delay Counts , 2004, Circulation.

[54]  M. Millar-Craig,et al.  Reduction in treatment delay by paramedic ECG diagnosis of myocardial infarction with direct CCU admission , 1997, Heart.

[55]  David O. Williams.  Treatment delayed is treatment denied. , 2004, Circulation.

[56]  M. P. Larsen,et al.  Incidence of cardiac arrest during self-transport for chest pain. , 1996, Annals of emergency medicine.

[57]  T. Aufderheide,et al.  A prospective evaluation of prehospital 12-lead ECG application in chest pain patients. , 1992, Journal of electrocardiology.

[58]  R. Stern,et al.  Efficiency of a physician-operated mobile intensive care unit for prehospital thrombolysis in acute myocardial infarction. , 1992, The American journal of cardiology.

[59]  E. Antman,et al.  Evaluation of the time saved by prehospital initiation of reteplase for ST-elevation myocardial infarction: results of The Early Retavase-Thrombolysis in Myocardial Infarction (ER-TIMI) 19 trial. , 2002, Journal of the American College of Cardiology.

[60]  W D Weaver,et al.  31st Bethesda Conference. Emergency Cardiac Care. Task force 2: Acute coronary syndromes: Section 2A--Prehospital issues. , 2000, Journal of the American College of Cardiology.

[61]  N. Terrin,et al.  Evaluation of technologies for identifying acute cardiac ischemia in emergency departments. , 2000, Evidence report/technology assessment.

[62]  J S Martin,et al.  Time delays in the diagnosis and treatment of acute myocardial infarction: a tale of eight cities. Report from the Pre-hospital Study Group and the Cincinnati Heart Project. , 1990, American heart journal.

[63]  R. Swor,et al.  Effects of EMS Transportation on Time to Diagnosis and Treatment of Acute Myocardial Infarction in the Emergency Department , 1994, Prehospital and Disaster Medicine.

[64]  P. Kudenchuk,et al.  Myocardial Infarction Triage and Intervention Project--phase I: patient characteristics and feasibility of prehospital initiation of thrombolytic therapy. , 1990, Journal of the American College of Cardiology.

[65]  S. Osganian,et al.  Impact of community intervention to reduce patient delay time on use of reperfusion therapy for acute myocardial infarction: rapid early action for coronary treatment (REACT) trial. REACT Study Group. , 2000, Academic emergency medicine : official journal of the Society for Academic Emergency Medicine.

[66]  S. Mavrogeni,et al.  Transmission of electrocardiograms from a moving ambulance , 1998, Journal of telemedicine and telecare.

[67]  T. Feldman,et al.  Cellular telephone transmission of 12-lead electrocardiograms from ambulance to hospital. , 1987, The American journal of cardiology.

[68]  David A. Edmondson,et al.  Prehospital 12-lead ECG diagnostic programs. , 2002, Emergency medicine clinics of North America.

[69]  T. Aufderheide,et al.  Planning, Implementation, and Process Monitoring for Prehospital 12-Lead ECG Diagnostic Programs , 1996, Prehospital and Disaster Medicine.

[70]  H. Suryapranata,et al.  Symptom-onset-to-balloon time and mortality in patients with acute myocardial infarction treated by primary angioplasty. , 2003, Journal of the American College of Cardiology.

[71]  David Antoniucci,et al.  Relation of time to treatment and mortality in patients with acute myocardial infarction undergoing primary coronary angioplasty. , 2002, The American journal of cardiology.

[72]  R. Califf,et al.  Need for Centers to Care for Patients With Acute Coronary Syndromes , 2003, Circulation.

[73]  D. Drake.  Cardiac team: an ED quality improvement success story. , 1998, Journal of emergency nursing: JEN : official publication of the Emergency Department Nurses Association.

[74]  C Lenfant,et al.  Timing is everything: motivating patients to call 9-1-1 at onset of acute myocardial infarction. , 2001, Circulation.

[75]  T. Aufderheide,et al.  Emergency Cardiac Care , 1994 .