• Phase shift in transmitted electrocardiograms: A cautionary tale of distorted signals

      Tayler, David; Hitt, Andy; Jolley, Brian; Sanders, Guy; Chamberlain, Douglas (2009-08-01)
    • PP19 Use and impact of the pre-hospital 12-lead electrocardiogram in the primary PCI era (PHECG2): mixed methods study protocol

      Munro, Scott; Gavalova, Lucia; Halter, Mary; Snooks, Helen; Gale, Chris P.; Weston, Clive; Watkins, Alan; Davies, Glenn; Hampton, Chelsey; Driscoll, Timothy; et al. (2019-09-24)
      Background The pre-hospital 12-lead electrocardiogram (PHECG) is recommended in patients presenting to emergency medical services (EMS) with suspected acute coronary syndrome (ACS). Prior research found PHECG was associated with improved 30-day survival, but a third of ACS patients under EMS care did not have PHECG. Such patients tended to be female, older and/or with comorbidities. This previous study was undertaken when thrombolytic treatment was the main treatment for ST segment elevation myocardial infarction (STEMI); practice has since shifted to a predominant interventional strategy – primary percutaneous coronary intervention (pPCI). Moreover, the previous study relied solely on data collected by the Myocardial Ischaemia National Audit Project (MINAP), which does not include information on symptoms, EMS personnel gender, and other factors that may influence decision-making. The PHECG2 study addresses the following research questions: a) Is there a difference in 30-day mortality and reperfusion between those who do and do not receive PHECG? b) Has the proportion of eligible patients who receive PHECG changed since the introduction of pPCI networks? c) Are patients that receive PHECG different from those that do not in social and demographic factors, and in pre-hospital clinical presentation? d) What factors do EMS clinicians report as influencing their decision to perform PHECG? Methods Explanatory sequential Quan-Qual mixed methods study comprising 4 Work Packages (WPs): WP1 a population based, linked data analysis of MINAP from 2010–2017 (n=510,000); WP2 retrospective chart review of EMS records from 3 EMS; WP3 focus groups with personnel from 3 EMS. WP4 will synthesise findings from WP1-3. Conclusions Gaining an understanding into the clinical and non-clinical factors influencing EMS clinicians’ decisions to record PHECG will enable us to develop (and later test through a randomised trial) an intervention to improve PHECG uptake and patient outcomes following an ACS event., https://emj.bmj.com/content/36/10/e9.1. This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ DOI http://dx.doi.org/10.1136/emermed-2019-999abs.19
    • The use and impact of 12-lead electrocardiograms in acute stroke patients: a systematic review

      Munro, Scott F.S.; Cooke, Debbie; Kiln-Barfoot, Valerie; Quinn, Tom (2018-04)
    • The use of prehospital 12-lead electrocardiograms in acute stroke patients

      Cooke, Debbie; Joy, Mark; Quinn, Tom (2018-04)
      AIM Emergency medical services (EMS) play a vital role in the recognition, management and transportation of acute stroke patients. UK guidelines recommend clinicians consider performing a prehospital 12-lead electrocardiogram (PHECG) in patients with suspected stroke , but this recommendation is based on expert consensus, rather than robust evidence. The aim of this study was to investigate the association between PHECG and modified Rankin scale (mRS). Secondary outcomes included in-hospital mortality, EMS and in-hospital time intervals and rates of thrombolysis received. Method A multicentre retrospective cohort study was undertaken. The data collection period spanned from 29/12/2013 – 30/01/2017. Participants were identified through secondary analysis of hospital data routinely collected as part of the Sentinel Stroke National Audit Programme (SSNAP) and linked to EMS clinical records (PCRs) via EMS incident number. Results PHECG was performed in 558 (48%) of study patients. PHECG was associated with an increase in mRS (aOR 1.44, 95% CI: 1.14 to 1.82, p=0.002) and in-hospital mortality (aOR 2.07, 95% CI: 1.42 to 3.00, p=0.0001). There was no association between PHECG and administration of thrombolysis (aOR 0.92, 95% CI: 0.65 to 1.30, p=0.63). Patients who had a PHECG recorded spent longer under the care of EMS (median 49 vs 43 min, p=0.007). No difference in times to receiving brain scan (Median 28 with PHECG vs 29 min no PHECG, p=0.14) or thrombolysis (median 46 min vs 48 min, p=0.82) were observed. Conclusion This is the first study of its kind to investigate the association between PHECG and functional outcome in stroke patients attended by EMS. Although there are limitations in Abstracts BMJ Open 2018;8(Suppl 1):A1–A34 A5 Trust (NHS). Protected by copyright. on September 3, 2019 at Manchester University NHS Foundation http://bmjopen.bmj.com/ BMJ Open: first published as 10.1136/bmjopen-2018-EMS.14 on 16 April 2018. Downloaded from regard to the retrospective study design, the findings challenge current guideline recommendations regarding PHECG in patients with acute stroke. https://bmjopen.bmj.com/content/bmjopen/8/Suppl_1/A5.3.full.pdf This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ http://dx.doi.org/10.1136/bmjopen-2018-EMS.14