Dwayne Young

Publications of Dwayne Young

• The stability of the ST segment estimation of myocardial area at risk between the prehospital and hospital electrocardiograms in patients with ST elevation myocardial infarction.

  Authors: Sjoerd Bouwmeester, Irene E G van Hellemond, Charles Maynard, Dwayne Young, Charles Bethea, Anton Gorgels, Galen S Wagner

  Journal of electrocardiology. 02/2011; 44(3):363-9.

  Several ST segment deviation scores have been developed to estimate the myocardial area at risk (AAR) during acute myocardial infarction (AMI), which can be used to measure the effectiveness ofSeveral ST segment deviation scores have been developed to estimate the myocardial area at risk (AAR) during acute myocardial infarction (AMI), which can be used to measure the effectiveness of reperfusion therapy. The purpose of this study was to assess whether one of these ST segment deviation scores (the Aldrich score) is sufficiently stable between the electrocardiogram (ECG) recorded in the ambulance (ECG 1) and the ECG recorded at the time of admission to the hospital (ECG 2) to be used as a baseline estimation of the AAR. The Aldrich scores were compared between ECG 1 and ECG 2 in 77 patients who met the criteria for ST elevation myocardial infarction. The ECGs had a time interval of at least 5 minutes and were recorded before reperfusion therapy. Sufficiently stable was defined as 95% of the patients did not show a temporal change of the Aldrich score of more than 4.5%. The mean time interval between ECG 1 and ECG 2 was 20 ± 9 minutes. Forty-three percent of the total study population showed an "unstable Aldrich score" between ECG 1 and ECG 2. Fifty-seven percent showed a "stable Aldrich score", which means that the 95% standard for sufficiently stable was not fulfilled. By dividing the population based on infarct location, the group with inferior AMI (n = 43) showed more stability (67%) than the group with anterior AMI (n = 34) (44%) (P < .05). However, this remains less than the 95% stability standard. For both inferior and anterior AMI locations, the Aldrich score was not sufficiently stable to be used as a reliable baseline estimation of the AAR in AMI.

• Overcoming barriers to developing seamless ST-segment elevation myocardial infarction care systems in the United States: recommendations from a comprehensive Prehospital 12-lead Electrocardiogram Working Group.

  Authors: Daniel M Frendl, Sebastian T Palmeri, J Robert Clapp, David Hampton, Maria Sejersten, Dwayne Young, Barbara Drew, Robert Farrell, Jan Innes, James Russell, G Ian Rowlandson, Yanina Purim-Shem-Tov, B Kevin Underhill, Sophia Zhou, Galen S Wagner

  Journal of electrocardiology. 06/2009;

  BACKGROUND: Reducing time to reperfusion treatment for patients with ST-segment elevation myocardial infarction (STEMI) improves patient outcomes. Few medical systems consistently meet currentBACKGROUND: Reducing time to reperfusion treatment for patients with ST-segment elevation myocardial infarction (STEMI) improves patient outcomes. Few medical systems consistently meet current benchmarks regarding timely access to treatment. Studies have widely demonstrated that prehospital 12-lead electrocardiography can facilitate early catheterization laboratory activation and is the most effective means of decreasing patients' time to treatment. METHODS: We gathered experts to examine the barriers to implementation of prehospital 12-lead electrocardiographic monitoring and transmission to in-hospital cardiologists in creating seamless STEMI care systems (STEMI-CS) and propose multidisciplinary approaches to overcoming these barriers. RESULTS AND CONCLUSIONS: Physicians, hospital systems, and emergency medical services often lack coordination of care delivery and receive fragmented funding and oversight. Clinical and regulatory guidelines do not emphasize local solutions to achieving clinical benchmarks, do not target incentives at all components of the STEMI-CS, and underemphasize risk-based approaches to protecting patient health. Integration of the multiple complex components involved in STEMI-CS is essential to improving care delivery.

• Effectiveness of prehospital wireless transmission of electrocardiograms to a cardiologist via hand-held device for patients with acute myocardial infarction (from the Timely Intervention in Myocardial Emergency, NorthEast Experience [TIME-NE]).

  Authors: George L Adams, Paul T Campbell, John M Adams, David G Strauss, Karen Wall, Janet Patterson, Kathy B Shuping, Charles Maynard, Dwayne Young, Craig Corey, Alan Thompson, Benjamin A Lee, Galen S Wagner

  The American journal of cardiology. 12/2006; 98(9):1160-4.

  Percutaneous coronary intervention for patients with ST-segment elevation myocardial infarction (STEMI) decreases morbidity and mortality if performed within the first 2 hours of symptom onset.Percutaneous coronary intervention for patients with ST-segment elevation myocardial infarction (STEMI) decreases morbidity and mortality if performed within the first 2 hours of symptom onset. However, the American College of Cardiology/American Heart Association guideline for percutaneous coronary intervention door-to-balloon time (<90 minutes) in patients with STEMI is a infrequently accomplished goal. This study enrolled 277 patients with STEMI who were self-transported or transported by emergency medical services to NorthEast Medical Center for primary percutaneous coronary intervention. This study tested the hypothesis that prehospital wireless transmission of an electrocardiogram to a cardiologist's hand-held device results in shorter emergency department door-to-reperfusion time. A comparison was made between patients whose electrocardiogram was successfully transmitted during the intervention phase with (1) patients transported by the emergency medical services in the preintervention, (2) patients self-transported in the intervention phase, and (3) patients whose wireless transmission failed in the intervention phase. During the preintervention phase (2001 to 2003), 48 patients were enrolled. During the intervention phase (2003 to 2005), the following patients were enrolled: 101 self-transported patients, 24 patients with successful electrocardiographic transmission, and 19 patients for whom transmission failed. The median door-to-reperfusion time for patients with successful electrocardiographic transmission was 50 minutes, which was significantly shorter than a preintervention time of 101 minutes (p <0.0001), an intervention phase self-transport time of 96 minutes (p <0.0001), and a failed transmission time of 78 minutes (p <0.0001). In conclusion, prehospital wireless electrocardiographic transmission to a cardiologist's hand-held device significantly decreased emergency department door-to-reperfusion time, thus achieving the American College of Cardiology/American Heart Association guideline for patients with STEMI.

• The future of STEMI response.

  Authors: Jonathan A Lipton, David G Strauss, Dwayne Young, Maria Sejersten, Charles Maynard, Creighton Vaught, Debra VerSteeg, Denise Munsey, James L Albright, Paul N Leibrandt, Samuel Bell, Samuel Jacubowitz, Thomas Wall, Galen Wagner

  JEMS : a journal of emergency medical services. 08/2006; 31(7):S8-12.

• Have we made progress in reducing time to reperfusion in the management of acute myocardial infarction? A last decade overview. The potential key role of wireless electrocardiographic transmission.

  Authors: Dwayne Young, Alex Barbagelata, Galen Wagner

  Journal of electrocardiology. 11/2005; 38(4 Suppl):94-5.

• Aborted infarction: the ultimate myocardial salvage.

  Authors: Lauren Dowdy, Galen S Wagner, Yochai Birnbaum, Peter Clemmensen, Yuling Fu, Charles Maynard, Ian Menown, Maria Sejersten, Dwayne Young, Per Johanson, Alejandro Barbagelata

  American heart journal. 04/2004; 147(3):390-4.

• Comparison of the ability of paramedics with that of cardiologists in diagnosing ST-segment elevation acute myocardial infarction in patients with acute chest pain.

  Authors: Maria Sejersten, Dwayne Young, Peter Clemmensen, Jonathan Lipton, Debra VerSteeg, Thomas Wall, Charles Maynard, Galen Wagner

  The American journal of cardiology. 12/2002; 90(9):995-8.

• Effectiveness of prehospital continuous positive airway pressure in the management of acute pulmonary edema.

  Authors: Michael W Hubble, Michael E Richards, Roger Jarvis, Tori Millikan, Dwayne Young

  Prehospital emergency care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors. 10(4):430-9.

  OBJECTIVE: To compare the effectiveness of continuous positive airway pressure (CPAP) with standard pharmacologic treatment in the management of prehospital acute pulmonary edema. METHODS: Using aOBJECTIVE: To compare the effectiveness of continuous positive airway pressure (CPAP) with standard pharmacologic treatment in the management of prehospital acute pulmonary edema. METHODS: Using a nonrandomized control group design, all consecutive patients presenting to two participating emergency medical services (EMS) systems with a field impression of acute pulmonary edema between July 1, 2004, and June 30, 2005, were included in the study. The control EMS system patients received standard treatment with oxygen, nitrates, furosemide, morphine, and, if indicated, endotracheal intubation. The intervention EMS system patients received CPAP via face mask at 10 cm H2O in addition to standard therapy. RESULTS: Ninety-five patients received standard therapy, and 120 patients received CPAP and standard therapy. Intubation was required in 8.9% of CPAP-treated patients compared with 25.3% in the control group (p = 0.003), and mortality was lower in the CPAP group than in the control group (5.4% vs. 23.2%; p = 0.000). When compared with the control group, the CPAP group had more improvement in respiratory rate (-4.55 vs. -1.81; p = 0.001), pulse rate (-4.77 vs. 0.82; p = 0.013), and dyspnea score (-2.11 vs. -1.36; p = 0.008). Using logistic regression to control for potential confounders, patients receiving standard treatment were more likely to be intubated (odds ratio, 4.04; 95% confidence interval, 1.64 to 9.95) and more likely to die (odds ratio, 7.48; 95% confidence interval, 1.96 to 28.54) than those receiving standard therapy and CPAP. CONCLUSION: The prehospital use of CPAP is feasible, may avert the need for endotracheal intubation, and may reduce short-term mortality.