Le May Michel R, Dionne Richard, Maloney Justin, Trickett John, Watpool Irene, Ruest Michel, Stiell Ian, Ryan Sheila, Davies Richard F
University of Ottawa Heart Institute, Ottawa, ON.
CJEM. 2006 Nov;8(6):401-7. doi: 10.1017/s1481803500014196.
Most studies of pre-hospital management of ST-elevation myocardial infarction (STEMI) have involved physicians accompanying the ambulance crew, or electrocardiogram (ECG) transmission to a physician at the base hospital. We sought to determine if Advanced Care Paramedics (ACPs) could accurately identify STEMI on the pre-hospital ECG and contribute to strategies that shorten time to reperfusion.
A STEMI tool was developed to: 1) measure the accuracy of the ACPs at diagnosing STEMI; and 2) determine the potential time saved if ACPs were to independently administer thrombolytic therapy. Using registry data, we subsequently estimated the time saved by initiating thrombolytic therapy in the field compared with in-hospital administration by a physician.
Between August 2003 and July 2004, a correct diagnosis of STEMI on the pre-hospital ECG was confirmed in 63 patients. The performance of the ACPs in identifying STEMI on the ECG resulted in a sensitivity of 95% (95% confidence interval [CI] 86%-99%), a specificity of 96% (95% CI 94%-98%), a positive predictive value (PPV) of 82% (95% CI 71%-90%), and a negative predictive value (NPV) of 99% (95% CI 97%-100%). ACP performance for appropriately using thrombolytic therapy resulted in a sensitivity of 92% (95% CI 78%-98%), a specificity of 97% (95% CI 94%-98%), a PPV of 73% (95% CI 59%-85%) and an NPV of 99% (95% CI 97%-100%). We estimated that the median time saved by ACP administration of thrombolytic therapy would have been 44 minutes.
ACPs can be trained to accurately interpret the pre-hospital ECG for the diagnosis of STEMI. These results are important for the design of regional integrated programs aimed at reducing delays to reperfusion.
大多数关于ST段抬高型心肌梗死（STEMI）院前管理的研究涉及随车医生，或将心电图（ECG）传输给基地医院的医生。我们试图确定高级急救护理人员（ACP）能否在院前心电图上准确识别STEMI，并为缩短再灌注时间的策略做出贡献。
开发了一种STEMI工具，用于：1）测量ACP诊断STEMI的准确性；2）确定如果ACP独立进行溶栓治疗可能节省的时间。利用登记数据，我们随后估计了与医生在医院给药相比，在现场启动溶栓治疗节省的时间。
在2003年8月至2004年7月期间，63例患者的院前心电图被确诊为STEMI。ACP在心电图上识别STEMI的表现导致灵敏度为95%（95%置信区间[CI]86%-99%），特异度为96%（95%CI 94%-98%），阳性预测值（PPV）为82%（95%CI 71%-90%），阴性预测值（NPV）为99%（95%CI 97%-100%）。ACP正确使用溶栓治疗的表现导致灵敏度为92%（95%CI 78%-98%），特异度为97%（95%CI 94%-98%），PPV为73%（95%CI 59%-85%），NPV为99%（95%CI 97%-100%）。我们估计，ACP进行溶栓治疗节省的中位时间为44分钟。
可以培训ACP准确解读院前心电图以诊断STEMI。这些结果对于旨在减少再灌注延迟的区域综合项目的设计很重要。
