Drew Barbara J, Sommargren Claire E, Schindler Daniel M, Zegre Jessica, Benedict Kent, Krucoff Mitchell W
Department of Physiological Nursing, N631H, University of California, San Francisco, CA 94143-0610, USA.
J Electrocardiol. 2006 Oct;39(4 Suppl):S157-60. doi: 10.1016/j.jelectrocard.2006.05.033.
The aims of this report are to (1) describe a novel prehospital 12-lead electrocardiogram (ECG) configuration and transmission procedure used in the Synthesized Twelve-lead ST Monitoring and Real-time Tele-electrocardiography Study and to (2) report on the frequency of arrhythmias in field ECGs compared with the first hospital ECG.
The Synthesized Twelve-lead ST Monitoring and Real-time Tele-electrocardiography Study is a 5-year randomized clinical trial ending in 2008. All emergency vehicles responding to 911 calls in Santa Cruz County, Calif, have been equipped with portable monitor defibrillators with a special study software that (1) synthesizes a 12-lead ECG from 5 electrodes, (2) measures ST amplitudes in all 12 leads every 30 seconds, and (3) automatically transmits an ECG to the target emergency department if there is a change in ST amplitude of 200 microV in 1 lead or more or 100 microV in 2 contiguous leads or more lasting 2.5 minutes. An initial ECG is transmitted by paramedics, which activates the software. Subsequent transmissions of ST event ECGs occur automatically without paramedic decision making.
Prehospital ECGs had a greater frequency of arrhythmias than the first hospital ECG in the group as a whole (n = 433; 33.3% vs 28.9%; P < or = .001), as well as the subgroup with acute coronary syndrome (n = 185; 30.3% vs 26.5%; P < or = .001). More tachyarrhythmias occurred in the field and slightly more bradyarrhythmias occurred at the time of the first hospital ECG.
Prehospital continuous 12-lead ST-segment ischemia monitoring with computer-assisted automatic mobile telephone transmission of ST event ECGs to the target hospital is feasible. More arrhythmias occur in the prehospital phase than are evident on the first hospital ECG.
本报告的目的是（1）描述在综合十二导联ST段监测与实时远程心电图研究中使用的一种新型院前12导联心电图（ECG）配置及传输程序，以及（2）报告现场心电图中心律失常的发生率，并与首次医院心电图进行比较。
综合十二导联ST段监测与实时远程心电图研究是一项为期5年的随机临床试验，于2008年结束。加利福尼亚州圣克鲁斯县所有响应911呼叫的急救车辆均配备了带有特殊研究软件的便携式监护除颤器，该软件可（1）从5个电极合成12导联心电图，（2）每30秒测量所有12导联的ST段振幅，以及（3）如果1个或更多导联的ST段振幅变化200微伏或2个或更多相邻导联的ST段振幅变化100微伏且持续2.5分钟，则自动将心电图传输至目标急诊科。初始心电图由护理人员传输，这会激活该软件。ST段事件心电图的后续传输自动进行，无需护理人员做出决策。
在整个研究组（n = 433；33.3%对28.9%；P≤0.001）以及急性冠状动脉综合征亚组（n = 185；30.3%对26.5%；P≤0.001）中，院前心电图中心律失常的发生率高于首次医院心电图。现场发生的快速性心律失常更多，而首次医院心电图检查时发生的缓慢性心律失常略多。
院前通过计算机辅助自动移动电话将ST段事件心电图传输至目标医院进行连续12导联ST段缺血监测是可行的。院前阶段发生的心律失常比首次医院心电图显示的更为明显。
