Effect of ambulance 12-lead ECG recording on times to hospital reperfusion in acute myocardial infarction.
OBJECTIVE
To review the evidence that recording a prehospital 12-lead electrocardiogram (ECG) reduces time from hospital arrival to initiation of reperfusion therapy for acute myocardial infarction (AMI).


METHODS
Medline search from 1966 to the present (articles in all languages) and examination of bibliographies.


METHODS
Published studies of prehospital 12-lead ECG recording that included control groups and reported time intervals from hospital arrival to start of reperfusion therapy.


METHODS
Eight articles satisfied selection criteria (two randomised controlled trials, four non-randomised interventional studies and two prospective observational studies).


RESULTS
Widely varying study methodologies precluded meta-analysis. All studies had methodological problems, but hospital delays were consistently reduced. Such improvements appear to be small in hospitals where delays are already minimal.


CONCLUSIONS
Little evidence is available to support routine prehospital 12-lead ECG recording if the median hospital time to reperfusion is already less than 30 minutes. Improvement of in-hospital treatment times may be a better initial strategy than prehospital 12-lead ECG recording, as this will benefit more patients and allow ambulance services to better allocate their available resources.
Brown
S G
SG
Department of Emergency Medicine, Royal Hobart Hospital, Tas. Simon.Brown@utas.edu.au
Galloway
D M
DM
D000552:Ambulances; D004562:Electrocardiography / Q000706:statistics & numerical data*; D006801:Humans; D009203:Myocardial Infarction / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D015425:Myocardial Reperfusion / Q000706:statistics & numerical data*; D016032:Randomized Controlled Trials as Topic; D015996:Survival Rate; D013996:Time and Motion Studies