Paramedic transtelephonic communication to cardiologist of clinical and electrocardiographic assessment for rapid reperfusion of ST-elevation myocardial infarction.
OBJECTIVE
We tested the hypothesis that paramedic recognition of ST-elevation myocardial infarction (STEMI) and cardiologist activation of the cardiac catheterization laboratory without transmission of the electrocardiogram reduces door-to-balloon times.


METHODS
We studied a consecutive series of patients suspected to have STEMI who were taken to the cardiac catheterization laboratory in the 6-month period before hotline implementation (historical controls) and during the first year of hotline use (intervention group, hotline; emergency medical service patients without hotline, concurrent controls).


RESULTS
Emergency medical services activated the hotline 47 times, and 25 patients were subsequently taken to the catheterization laboratory. Patients who received PCI involving hotline use (n = 20) had significantly shorter door-to-balloon times (58 minutes; 25th-75th percentile, 52-73 minutes) than historical controls (n = 15) (112 minutes; 25th-75th percentile, 81-137; P < .0001) and concurrent controls (n = 15) (92 minutes; 25th-75th percentile, 76-112; P = .019).


CONCLUSIONS
Paramedic transtelephonic communication to cardiologist of clinical and electrocardiogram assessment resulted in a 54-minute reduction in door-to-balloon time for patients with STEMI.
Strauss
David G
DG
School of Medicine, Duke University, Durham, NC, USA. david.strauss@duke.edu
Sprague
Paula Quintal
PQ
Underhill
Kevin
K
Maynard
Charles
C
Adams
George L
GL
Kessenich
Amy
A
Sketch
Michael H
MH
Berger
Peter B
PB
Marcozzi
David
D
Granger
Christopher B
CB
Wagner
Galen S
GS
D002309:Cardiology / Q000379:methods; D040421:Cell Phone; D001026:Coronary Artery Bypass / Q000379:methods; D004562:Electrocardiography / Q000379:methods*; D004632:Emergency Medical Services / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis* / Q000601:surgery*; D015425:Myocardial Reperfusion / Q000379:methods*; D009657:North Carolina; D011785:Quality Assurance, Health Care / Q000379:methods; D019114:Remote Consultation / Q000379:methods*; D017216:Telemedicine / Q000379:methods*; D013997:Time Factors; D013996:Time and Motion Studies; D016896:Treatment Outcome