Twelve-Lead Electrocardiogram Acquisition With a Patchy-Type Wireless Device in Ambulance Transport: Simulation-Based Randomized Controlled Trial

Sunyoung Yoon, Taerim Kim, Taehwan Roh, Hansol Chang, Sung Yeon Hwang, Hee Yoon, Tae Gun Shin, Min Seob Sim, Ik Joon Jo, Won Chul Cha, Sunyoung Yoon, Taerim Kim, Taehwan Roh, Hansol Chang, Sung Yeon Hwang, Hee Yoon, Tae Gun Shin, Min Seob Sim, Ik Joon Jo, Won Chul Cha

Abstract

Background: Cardiovascular disease is the leading cause of death worldwide. Early recognition, diagnosis, and reperfusion are the key elements of treatment for ST-segment elevation myocardial infarction. The absence of a prehospital 12-lead electrocardiogram (P12ECG) can cause definitive treatment delay and repeated transfer. Although guidelines highly recommend the measurement and transmission of P12ECG data, P12ECG use has not been widely established.

Objective: The aim of this study was to verify the time-efficiency and feasibility of the use of a patchy-type 12-lead ECG measuring and transmitting device (P-ECG) by an emergency medical technician (EMT) in an ambulance during patient transport.

Methods: This was a simulation-based prospective randomized crossover-controlled study that included EMTs. The participants were randomly assigned to one of two groups. Group A began the experiment with a conventional 12-lead ECG (C-ECG) device and then switched to the intervention device (P-ECG), whereas group B began the experiment with the P-ECG and then switched to the C-ECG. All simulations were performed inside an ambulance driving at 30 km/h. The time interval was measured from the beginning of ECG application to completion of sending the results. After the simulation, participants were administered the System Usability Scale questionnaire about usability of the P-ECG.

Results: A total of 18 EMTs were recruited for this study with a median age of 35 years. The overall interval time for the C-ECG was 254 seconds (IQR 247-270), whereas the overall interval time for the P-ECG was 130 seconds (IQR 112-150), with a significant difference (P<.001). Significant differences between the C-ECG and P-ECG were identified at all time intervals, in which the P-ECG device was significantly faster in all intervals, except for the preparation interval in which the C-ECG was faster (P=.03).

Conclusions: Performance of 12-lead ECG examination and transmission of the results using P-ECG are faster than those of C-ECG during ambulance transport. With the additional time afforded, EMTs can provide more care to patients and transport patients more rapidly, which may help reduce the symptoms-to-balloon time for patients with acute coronary syndrome.

Trial registration: ClinicalTrials.gov NCT04114760; https://www.clinicaltrials.gov/ct2/show/NCT04114760.

Keywords: 12-lead electrocardiogram; ECG; EMT; cardiovascular; efficiency; electrocardiogram; electrocardiogram transmission; feasibility; prehospital; wearable; wearable patch device.

Conflict of interest statement

Conflicts of Interest: TR is the CEO of HEALTHRIAN, which developed wearECG12 that was used as our intervention device in the study. The other authors have no conflicts of interest to declare.

©Sunyoung Yoon, Taerim Kim, Taehwan Roh, Hansol Chang, Sung Yeon Hwang, Hee Yoon, Tae Gun Shin, Min Seob Sim, Ik Joon Jo, Won Chul Cha. Originally published in JMIR mHealth and uHealth (http://mhealth.jmir.org), 01.04.2021.

Figures

Figure 1
Figure 1
(A) The conventional 12-lead electrocardiogram device used for the control condition (X-series, ZOLL Medical, Chelmsford, MA, USA). (B) Attachment of electrodes on the patient's body surface, which are connected to the main device.
Figure 2
Figure 2
(A) Patchy-type wireless 12-lead electrocardiogram used for the intervention condition (HEALTHRIAN, Yuseong-gu, Daejeon, Republic of Korea). The device consists of two parts: a flexible patch with a socket and a transmitter. (B) Application of the device with the transmitter on the patient’s left chest area.
Figure 3
Figure 3
Definition of outcomes (intervals). The overall interval was defined as the interval from the "start" command to the acquisition of an electrocardiogram (ECG) image by a remote provider. C-ECG: conventional electrocardiogram; P-ECG: patchy-type electrocardiogram.
Figure 4
Figure 4
Case-crossover design study process. There was a washout period before two trials. C-ECG: conventional 12-lead electrocardiogram; P-ECG: patchy-type wireless 12-lead electrocardiogram.

References

    1. Ibanez B, James S, Agewall S, Antunes M, Bucciarelli-Ducci C, Bueno H, Caforio ALP, Crea F, Goudevenos JA, Halvorsen S, Hindricks G, Kastrati A, Lenzen MJ, Prescott E, Roffi M, Valgimigli M, Varenhorst C, Vranckx P, Widimský P, ESC Scientific Document Group 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: The Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC) Eur Heart J. 2018 Jan 07;39(2):119–177. doi: 10.1093/eurheartj/ehx393.
    1. GBD 2017 Causes of Death Collaborators Global, regional, and national age-sex-specific mortality for 282 causes of death in 195 countries and territories, 1980-2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet. 2018 Nov 10;392(10159):1736–1788. doi: 10.1016/S0140-6736(18)32203-7.
    1. GBD 2016 Causes of Death Collaborators Global, regional, and national age-sex specific mortality for 264 causes of death, 1980-2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet. 2017 Sep 16;390(10100):1151–1210. doi: 10.1016/S0140-6736(17)32152-9.
    1. O'Gara P, Kushner F, Ascheim D, Casey DJ, Chung M, de Lemos JA, Ettinger SM, Fang JC, Fesmire FM, Franklin BA, Granger CB, Krumholz HM, Linderbaum JA, Morrow DA, Newby LK, Ornato JP, Ou N, Radford MJ, Tamis-Holland JE, Tommaso CL, Tracy CM, Woo YJ, Zhao DX, Anderson JL, Jacobs AK, Halperin JL, Albert NM, Brindis RG, Creager MA, DeMets D, Guyton RA, Hochman JS, Kovacs RJ, Kushner FG, Ohman EM, Stevenson WG, Yancy CW, American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines 2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation. 2013 Jan 29;127(4):e362–e425. doi: 10.1161/CIR.0b013e3182742cf6.
    1. Studencan M, Alusik D, Plachy L, Bajerovska L, Ilavsky M, Karas J, Kilianova A, Sykora J, Hosa V, Kmec J, Slanina M, Boguska D. Significant benefits of new communication technology for time delay management in STEMI patients. PLoS One. 2018;13(11):e0205832. doi: 10.1371/journal.pone.0205832.
    1. Zègre Hemsey JK, Drew BJ. Prehospital electrocardiography: a review of the literature. J Emerg Nurs. 2012 Jan;38(1):9–14. doi: 10.1016/j.jen.2011.09.001.
    1. Quinn T, Johnsen S, Gale CP, Snooks H, McLean S, Woollard M, Weston C, Myocardial Ischaemia National Audit Project (MINAP) Steering Group Effects of prehospital 12-lead ECG on processes of care and mortality in acute coronary syndrome: a linked cohort study from the Myocardial Ischaemia National Audit Project. Heart. 2014 Jun;100(12):944–950. doi: 10.1136/heartjnl-2013-304599.
    1. Zègre-Hemsey JK, Asafu-Adjei J, Fernandez A, Brice J. Characteristics of prehospital electrocardiogram use in North Carolina using a novel linkage of emergency medical services and emergency department data. Prehosp Emerg Care. 2019;23(6):772–779. doi: 10.1080/10903127.2019.1597230.
    1. Bosson N, Kaji AH, Niemann JT, Squire B, Eckstein M, French WJ, Rashi P, Tadeo R, Koenig W. The utility of prehospital ECG transmission in a large EMS system. Prehosp Emerg Care. 2015;19(4):496–503. doi: 10.3109/10903127.2015.1005260.
    1. Sowizdraniuk J, Smereka J, Ladny J, Kaserer A, Palimonka K, Ruetzler K, Skierczynska A, Szarpak L. ECG pre-hospital teletransmission by emergency teams staffed with an emergency physician and paramedics and its impact on transportation and hospital admission. Medicine (Baltimore) 2019 Aug;98(34):e16636. doi: 10.1097/MD.0000000000016636.
    1. Larochelle N, O'Keefe M, Wolfson D, Freeman K. Cellular technology improves transmission success of pre-hospital electrocardiograms. Am J Emerg Med. 2013 Nov;31(11):1564–1570. doi: 10.1016/j.ajem.2013.07.032.
    1. Gonzalez M, Satler L, Rodrigo M, Gaglia MJ, Ben-Dor I, Maluenda G, Hanna N, Suddath WO, Torguson R, Pichard AD, Waksman R. Cellular video-phone assisted transmission and interpretation of prehospital 12-lead electrocardiogram in acute st-segment elevation myocardial infarction. J Interv Cardiol. 2011 Apr;24(2):112–118. doi: 10.1111/j.1540-8183.2010.00609.x.
    1. Bansal A, Joshi R. Portable out-of-hospital electrocardiography: A review of current technologies. J Arrhythm. 2018 Apr;34(2):129–138. doi: 10.1002/joa3.12035.
    1. Steijlen AS, Jansen KM, Albayrak A, Verschure DO, Van Wijk DF. A novel 12-lead electrocardiographic system for home use: development and usability testing. JMIR Mhealth Uhealth. 2018 Jul 30;6(7):e10126. doi: 10.2196/10126.
    1. Alis C, del Rosario C, Buenaobra B, Mar Blanca C. Lifelink: 3G-based mobile telemedicine system. Telemed J E Health. 2009 Apr;15(3):241–247. doi: 10.1089/tmj.2008.0098.
    1. Cha YD, Yoon G. Ubiquitous health monitoring system for multiple users using a ZigBee and WLAN dual-network. Telemed J E Health. 2009 Nov;15(9):891–897. doi: 10.1089/tmj.2009.0049.
    1. Orlov OI, Drozdov DV, Doarn CR, Merrell RC. Wireless ECG monitoring by telephone. Telemed J E Health. 2001;7(1):33–38. doi: 10.1089/153056201300093877.
    1. Woodward B, Istepanian R, Richards C. Design of a telemedicine system using a mobile telephone. IEEE Trans Inf Technol Biomed. 2001 Mar;5(1):13–15. doi: 10.1109/4233.908361.
    1. Zhao X, Fei D, Doarn CR, Harnett B, Merrell R. A telemedicine system for wireless home healthcare based on Bluetooth and the Internet. Telemed J E Health. 2004;10(Suppl 2):S-110-6.
    1. G*Power: Statistical Power Analyses for Windows and Mac. Heinrich Heine Universität Düsseldorf. [2020-12-22]. .
    1. Brooke J. SUS-a quick and dirty usability scale. In: Jordan PW, Thomas B, McClelland IL, Weerdmeester B, editors. Usability Evaluation in Industry. London: Taylor & Francis; 1996. Jun 11, pp. 189–194.
    1. Bangor A, Kortum P, Miller J. Determining what individual SUS scores mean: adding an adjective rating scale. J Usability Stud. 2009 May;4(3):114–123.
    1. Barquera S, Pedroza-Tobías A, Medina C, Hernández-Barrera L, Bibbins-Domingo K, Lozano R, Moran AE. Global overview of the epidemiology of atherosclerotic cardiovascular disease. Arch Med Res. 2015 Jul;46(5):328–338. doi: 10.1016/j.arcmed.2015.06.006.
    1. AlGhatrif M, Lindsay J. A brief review: history to understand fundamentals of electrocardiography. J Community Hosp Intern Med Perspect. 2012;2(1):14383. doi: 10.3402/jchimp.v2i1.14383.
    1. Grim P, Feldman T, Martin M, Donovan R, Nevins V, Childers RW. Cellular telephone transmission of 12-lead electrocardiograms from ambulance to hospital. Am J Cardiol. 1987 Sep 15;60(8):715–720. doi: 10.1016/0002-9149(87)90388-2.
    1. Aufderheide TP, Hendley GE, Thakur R, Mateer JR, Stueven HA, Olson DW, Hargarten KM, Laitinen F, Robinson N, Preuss KC. The diagnostic impact of prehospital 12-lead electrocardiography. Ann Emerg Med. 1990 Nov;19(11):1280–1287. doi: 10.1016/s0196-0644(05)82288-7.
    1. Hsieh J, Lin B, Wu F, Chang P, Tsuei Y, Yang C. Ambulance 12-lead electrocardiography transmission via cell phone technology to cardiologists. Telemed J E Health. 2010 Oct;16(8):910–915. doi: 10.1089/tmj.2010.0034.
    1. Werman HA, Newland R, Cotton B. Transmission of 12-lead electrocardiographic tracings by emergency medical technician-basics and emergency medical technician-intermediates: a feasibility study. Am J Emerg Med. 2011 May;29(4):437–440. doi: 10.1016/j.ajem.2010.01.015.
    1. Garvey JL, MacLeod BA, Sopko G, Hand MM, National Heart Attack Alert Program (NHAAP) Coordinating Committee. National Heart‚ Lung‚ Blood Institute (NHLBI) National Institutes of Health 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 Feb 07;47(3):485–491. doi: 10.1016/j.jacc.2005.08.072.
    1. Ouellette L, VanDePol E, Chassee T, Tavares E, Flannigan M, Jones J. Emergency department electrocardiogram images sent through the mobile phone: feasibility and accuracy. Am J Emerg Med. 2018 Apr;36(4):731–732. doi: 10.1016/j.ajem.2017.09.010.
    1. Faxon DP. Early reperfusion strategies after acute ST-segment elevation myocardial infarction: the importance of timing. Nat Clin Pract Cardiovasc Med. 2005 Jan;2(1):22–28. doi: 10.1038/ncpcardio0065.
    1. Nissen SE. Saving lives in acute ST-elevation myocardial infarction: the door-to-balloon initiative. Curr Cardiol Rep. 2007 Apr;9(2):79–81. doi: 10.1007/BF02938331.
    1. Bassand J, Danchin N, Filippatos G, Gitt A, Hamm C, Silber S, Tubaro M, Weidinger F. Implementation of reperfusion therapy in acute myocardial infarction. A policy statement from the European Society of Cardiology. Eur Heart J. 2005 Dec;26(24):2733–2741. doi: 10.1093/eurheartj/ehi673.

Source: PubMed

Sponzoři a spolupracovníci

Zdravotní podmínky

Drogové intervence

3
Předplatit