Al-Zaiti Salah S, Shusterman Vladimir, Carey Mary G
School of Nursing at University of Pittsburgh, Pittsburgh, PA, USA.
J Electrocardiol. 2013 Nov-Dec;46(6):540-5. doi: 10.1016/j.jelectrocard.2013.07.002. Epub 2013 Aug 29.
Current guidelines recommend early reperfusion therapy for ST-elevation myocardial infarction (STEMI) within 90 min of first medical encounter. Telecardiology entails the use of advanced communication technologies to transmit the prehospital 12-lead electrocardiogram (ECG) to offsite cardiologists for early triage to the cath lab; which has been shown to dramatically reduce door-to-balloon time and total mortality. However, hospitals often find adopting ECG transmission technologies very challenging. The current review identifies seven major technical challenges of prehospital ECG transmission, including: paramedics inconvenience and transport delay; signal noise and interpretation errors; equipment malfunction and transmission failure; reliability of mobile phone networks; lack of compliance with the standards of digital ECG formats; poor integration with electronic medical records; and costly hardware and software pre-requisite installation. Current and potential solutions to address each of these technical challenges are discussed in details and include: automated ECG transmission protocols; annotatable waveform-based ECGs; optimal routing solutions; and the use of cloud computing systems rather than vendor-specific processing stations. Nevertheless, strategies to monitor transmission effectiveness and patient outcomes are essential to sustain initial gains of implementing ECG transmission technologies.
当前指南推荐对ST段抬高型心肌梗死（STEMI）患者在首次医疗接触后90分钟内进行早期再灌注治疗。远程心脏病学利用先进的通信技术将院前12导联心电图（ECG）传输给异地心脏病专家以便早期分诊至导管室；这已被证明可显著缩短门球时间并降低总死亡率。然而，医院常常发现采用心电图传输技术极具挑战性。本综述确定了院前心电图传输的七个主要技术挑战，包括：护理人员不便及运输延迟；信号噪声和解读错误；设备故障及传输失败；移动电话网络的可靠性；不符合数字心电图格式标准；与电子病历整合不佳；以及昂贵的硬件和软件前期安装要求。详细讨论了应对这些技术挑战的现有及潜在解决方案，包括：自动心电图传输协议；基于可注释波形的心电图；最佳路由解决方案；以及使用云计算系统而非特定供应商的处理站。尽管如此，监测传输有效性和患者预后的策略对于维持实施心电图传输技术的初步成效至关重要。
