Aufderheide T P, Keelan M H, Hendley G E, Robinson N A, Hastings T E, Lewin R F, Hewes H F, Daniel A, Engle D, Gimbel B K
Department of Emergency Medicine, Medical College of Wisconsin, Milwaukee 53226.
Am J Cardiol. 1992 Apr 15;69(12):991-6. doi: 10.1016/0002-9149(92)90852-p.
This study prospectively determined the feasibility and accuracy of prehospital thrombolytic therapy candidate selection by base station emergency physicians. During a 6-month period, paramedics acquired and transmitted prehospital 12-lead electrocardiograms (ECGs) and then applied a thrombolytic therapy contraindication checklist. Emergency physicians interpreted prehospital ECGs and prospectively selected candidates for thrombolytic therapy. A safety committee of cardiologists reviewed prehospital ECGs, checklists and hospital records to determine accuracy independently. Six hundred-eighty stable adult prehospital patients with a chief complaint of nontraumatic chest pain were initially evaluated. Two hundred forty-one patients were excluded because of (1) unsuccessful electrocardiographic transmission (149), (2) transport to nonparticipating facilities (72), and (3) unavailable medical records (20). No prehospital thrombolytic therapy was administered in this study. Of 439 cases, 91 (21%) had the final diagnosis of acute myocardial infarction, 38 (8.7%) had diagnostic prehospital ECGs, and 12 (2.7%) were selected by emergency physicians as candidates for thrombolytic therapy. Seventy percent of patients with myocardial infarction had checklist exclusions for thrombolytic therapy. Prehospital evaluation increased mean scene time (paramedic arrival on scene to scene departure) by 4 minutes. The median time from chest pain onset to paramedic arrival in patients with myocardial infarction was 60 minutes. The estimated average time saved if prehospital thrombolytic therapy had been available was 101 +/- 81 minutes. The safety committee concluded that acceptable accuracy of emergency physician prehospital electrocardiographic interpretation, checklist and case selection was achieved. It is concluded that emergency physicians can accurately identify candidates for prehospital thrombolytic therapy.
本研究前瞻性地确定了基站急诊科医生进行院前溶栓治疗候选者选择的可行性和准确性。在6个月的时间里，护理人员获取并传输院前12导联心电图（ECG），然后应用溶栓治疗禁忌检查表。急诊科医生解读院前ECG，并前瞻性地选择溶栓治疗候选者。一个心脏病专家安全委员会审查院前ECG、检查表和医院记录以独立确定准确性。最初评估了680例以非创伤性胸痛为主诉的稳定成年院前患者。241例患者被排除，原因如下：（1）心电图传输不成功（149例），（2）转运至非参与机构（72例），以及（3）病历不可用（20例）。本研究中未进行院前溶栓治疗。在439例病例中，91例（21%）最终诊断为急性心肌梗死，38例（8.7%）有诊断性院前ECG，12例（2.7%）被急诊科医生选为溶栓治疗候选者。70%的心肌梗死患者因检查表原因被排除在溶栓治疗之外。院前评估使平均现场时间（护理人员到达现场至离开现场）增加了4分钟。心肌梗死患者从胸痛发作到护理人员到达的中位时间为60分钟。如果有院前溶栓治疗，估计平均节省时间为101±81分钟。安全委员会得出结论，急诊科医生对院前心电图的解读、检查表和病例选择具有可接受的准确性。结论是，急诊科医生可以准确识别院前溶栓治疗的候选者。
