Journal of Medicine and Life Science

  • 제21권2호
  • /
  • Pages.31-39
  • /
  • 2024
  • /
  • 1738-1010(pISSN)
  • /
  • 2671-4922(eISSN)
제주대학교 의과학연구소 (Institute for Medical Science)
권호 표지
DOI QR코드

DOI QR Code

Diagnostic performance of emergency medical technician for ST-segment elevation myocardial infarction

  • Soo Hoon Lee (Department of Emergency Medicine, Jeju National University Hospital, Jeju National University College of Medicine) ;
  • Daesung Lim (Department of Emergency Medicine, Seoul Medical Center) ;
  • Seo Young Ko (Department of Emergency Medicine, Jeju National University Hospital, Jeju National University College of Medicine)
  • 투고 : 2024.02.01
  • 심사 : 2024.04.18
  • 발행 : 2024.05.31
PDF 다운로드
⟨ 이전 논문 다음 논문 ⟩

초록

This study was conducted to determine whether level-1 emergency medical technicians (EMTs) can adequately recognize ST-segment elevation myocardial infarction (STEMI) in the emergency department (ED) and whether their ability to do so differs from that of emergency medicine physicians (EMP). From December 2022 to November 2023, patients aged 20 years or older visiting the ED with chief complaints suggesting acute coronary syndrome (ACS) were enrolled. As soon as the patient arrived at the ED, a level-1 EMT conducted a 12-lead electrocardiogram (ECG) to assess STEMI; an EMP subsequently assessed whether to activate the percutaneous coronary intervention team. Demographic characteristics, test results, and final diagnoses were collected from the medical records. Among the 723 patients with case report forms, 720 were included in the analysis. These were categorized as follows: 117 (16.3%) with STEMI, 159 (22.1%) with non-ST-segment elevation ACS, and 444 (61.7%) with other conditions. STEMI was correctly recognized in 100 patients (91.7%) by level-1 EMTs and in 104 patients (95.4%) by EMPs (kappa=0.646). EMTs with less than 1 year of ED work experience correctly recognized 60 out of 67 STEMI patients (89.6%), which was comparable with the EMPs who recognized 65 out of 67 STEMI patients (97.0%, kappa=0.614). EMTs with more than 1 year of ED work correctly recognized 40 out of 42 STEMI patients (95.2%), and therefore performed better than EMPs, who recognized 39 out of 42 STEMI patients (92.9%, kappa=0.727). The level-1 EMTs adequately recognized STEMI using a 12-lead ECG and were in substantial agreement with the evaluations of the EMPs.

키워드

과제정보

This work was supported by a research grant from Jeju National University Hospital in 2022.

참고문헌

  1. De Luca G, van 't Hof AW, de Boer MJ, Ottervanger JP, Hoorntje JC, Gosselink AT, et al. Time-to-treatment significantly affects the extent of ST-segment resolution and myocardial blush in patients with acute myocardial infarction treated by primary angioplasty. Eur Heart J 2004;25:1009-13.  https://doi.org/10.1016/j.ehj.2004.03.021
  2. De Luca G, Suryapranata H, Ottervanger JP, Antman EM. Time delay to treatment and mortality in primary angioplasty for acute myocardial infarction: every minute of delay counts. Circulation 2004;109:1223-5.  https://doi.org/10.1161/01.CIR.0000121424.76486.20
  3. Garvey JL, MacLeod BA, Sopko G, Hand MM; National Heart Attack Alert Program (NHAAP) Coordinating Committee; National Heart, Lung, and Blood Institute (NHLBI); et al. Pre-hospital 12-lead electrocardiography programs: a call for implementation by emergency medical services systems providing advanced life support--National Heart Attack Alert Program (NHAAP) Coordinating Committee; National Heart, Lung, and Blood Institute (NHLBI); National Institutes of Health. J Am Coll Cardiol 2006;47:485-91.  https://doi.org/10.1016/j.jacc.2005.08.072
  4. Le May MR, So DY, Dionne R, Glover CA, Froeschl MP, Wells GA, et al. A citywide protocol for primary PCI in ST-segment elevation myocardial infarction. N Engl J Med 2008;358:231-40.  https://doi.org/10.1056/NEJMoa073102
  5. O'Connor RE, Ali ASA, Brady WJ, Ghaemmaghami CA, Menon V, Welsford M, et al. Part 9: acute coronary syndromes: 2015 American Heart Association guidelines update for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation 2015;132(Suppl 2):S483-500.  https://doi.org/10.1161/CIR.0000000000000263
  6. Byrne RA, Rossello X, Coughlan JJ, Barbato E, Berry C, Chieffo A, et al. 2023 ESC guidelines for the management of acute coronary syndromes. Eur Heart J Acute Cardiovasc Care 2024;13:55-161.  https://doi.org/10.1093/ehjacc/zuad107
  7. Aufderheide TP, Kereiakes DJ, Weaver WD, Gibler WB, Simoons ML. Planning, implementation, and process monitoring for prehospital 12-lead ECG diagnostic programs. Prehosp Disaster Med 1996;11:162-71.  https://doi.org/10.1017/S1049023X00042904
  8. Rajabali NA, Tsuyuki RT, Sookram S, Simpson SH, Welsh RC. Evaluating the views of paramedics, cardiologists, emergency department physicians and nurses on advanced prehospital management of acute ST elevation myocardial infarction. Can J Cardiol 2009;25:e323-8.  https://doi.org/10.1016/S0828-282X(09)70146-1
  9. National Fire Agency. First aid equipment retention criteria [Internet]. Sejong: Korean Law Information Center; c2018 [cited 2024 Mar 14]. Available from: https://www.law.go.kr/%ED%96%89%EC%A0%95%EA%B7%9C%EC%B9%99/%EA%B5%AC%EA%B8%89%EC%9E%A5%EB%B9%84%EB%B3%B4%EC%9C%A0%EA%B8%B0%EC%A4%80/(2018-18,20181207). 
  10. Shin SD. A study on the improvement of emergency medical system [Internet]. Seoul: National Assembly Budget Office; c2018 [cited 2024 Mar 14]. Available from: https://nsp.nanet.go.kr/plan/subject/detail.do?nationalPlanControlNo=PLAN0000038586. 
  11. Jang JY, Park CB, Lee EJ, Lee YJ, Shin SD, Song KJ. Diagnostic test performance characteristics of ST-segment elevation myocardial infarction by level 1 emergency medical technicians before vs after an electrocardiogram education program. J Korean Soc Emerg Med 2010;21:539-45. 
  12. Trivedi K, Schuur JD, Cone DC. Can paramedics read ST-segment elevation myocardial infarction on prehospital 12-lead electrocardiograms? Prehosp Emerg Care 2009;13:207-14.  https://doi.org/10.1080/10903120802706153
  13. Huitema AA, Zhu T, Alemayehu M, Lavi S. Diagnostic accuracy of ST-segment elevation myocardial infarction by various healthcare providers. Int J Cardiol 2014;177:825-9.  https://doi.org/10.1016/j.ijcard.2014.11.032
  14. Ting HH, Krumholz HM, Bradley EH, Cone DC, Curtis JP, Drew BJ, et al. Implementation and integration of prehospital ECGs into systems of care for acute coronary syndrome: a scientific statement from the American Heart Association Interdisciplinary Council on Quality of Care and Outcomes Research, Emergency Cardiovascular Care Committee, Council on Cardiovascular Nursing, and Council on Clinical Cardiology. Circulation 2008;118:1066-79. https://doi.org/10.1161/CIRCULATIONAHA.108.190402