Søren Loumann Nielsen

Publications of Søren Loumann Nielsen

• Pharmacotherapy and hospital admissions before out-of-hospital cardiac arrest: a nationwide study.

  Authors: Peter Weeke, Fredrik Folke, Gunnar H Gislason, Freddy K Lippert, Jonas B Olesen, Charlotte Andersson, Emil L Fosbøl, Mette G Charlot, Jørgen K Kanters, Henrik E Poulsen, Søren Loumann Nielsen, Lars Køber, Christian Torp-Pedersen

  Resuscitation. 12/2010; 81(12):1657-63.

  For out-of-hospital cardiac arrest (OHCA) to be predicted and prevented, it is imperative the healthcare system has access to those vulnerable before the event occurs. We aimed to determine theFor out-of-hospital cardiac arrest (OHCA) to be predicted and prevented, it is imperative the healthcare system has access to those vulnerable before the event occurs. We aimed to determine the extent of contact to the healthcare system before OHCA. All patients in Denmark with a registered OHCA June 1, 2001-December 31, 2005 were matched on age and sex with 10 random controls from the entire Danish population. We estimated the association with OHCA by conditional logistic regression analyses, and we determined the proportion of patients in contact with the healthcare system before OHCA from hospital admissions or claimed prescriptions. We identified 12,089 patients with an OHCA. Of these, 62% (7548) and 85% (10,312) were in contact with the healthcare system up to 30 days and 1 year before OHCA, respectively. Association with OHCA up to 30 days before the event pertained to myocardial infarction (odds ratio (OR)=6.4, 95% confidence interval (CI): 4.7-8.6)); heart failure (OR=5.1, CI: 4.1-6.3); ischemic heart disease (OR=1.9, CI: 1.6-2.4); and cardiac dysrhythmia (OR=1.8, CI: 1.4-2.2). Concomitant pharmacotherapy up to 30 days before OHCA with the strongest association was: corticosteroids (systemic) (OR=2.7, CI: 2.5-3.0), bronchial dilators (OR=2.5, CI: 2.3-2.7), anti-psychotic medication (OR=2.1, CI: 1.9-2.3), and digoxin (OR=2.1, CI: 2.0-2.3). Similar results were found for associations up to 1 year before OHCA. Contrary to general belief, the majority of OHCA patients are in contact with the healthcare system shortly before OHCA.

• Response interval is important for survival until admission after prehospital cardiac arrest.

  Authors: Hien Quoc Do, Søren Loumann Nielsen, Lars Simon Rasmussen

  Danish medical bulletin. 12/2010; 57(12):A4203.

  An increasing distance to the nearest hospital must be expected as a result of centralization of acute care at a small number of hospitals. This may have important consequences in emergencyAn increasing distance to the nearest hospital must be expected as a result of centralization of acute care at a small number of hospitals. This may have important consequences in emergency situations, such as prehospital or out-of-hospital cardiac arrest (OHCA) where the aim is to obtain return of spontaneous circulation (ROSC), i.e. successful resuscitation. The aim of this study was to describe the impact of response interval on sustained ROSC, i.e. ROSC at hospital admission, after OHCA with presumed cardiac aetiology. We included all OHCA calls in which the Copenhagen Mobile Emergency Care Unit (MECU) was involved during the 2002-2008 period. Data were collected prospectively and the primary endpoint was sustained ROSC. Resuscitation was attempted in 2,678 OHCA cases. Among these, cardiac aetiology was presumed in 2,327 cases, and 745 patients (32.0%) achieved sustained ROSC. The mean response interval was significantly shorter for patients who obtained sustained ROSC (370 seconds) than for patients who did not (394 seconds) (p = 0.015). A significantly shorter response interval was observed in patients who were successfully resuscitated after out-of-hospital cardiac arrest than in patients who were not successfully resuscitated.

• Location of Cardiac Arrest in a City Center. Strategic Placement of Automated External Defibrillators in Public Locations.

  Authors: Fredrik Folke, Freddy Knudsen Lippert, Søren Loumann Nielsen, Gunnar Hilmar Gislason, Morten Lock Hansen, Tina Ken Schramm, Rikke Sørensen, Emil Loldrup Fosbøl, Søren Skøtt Andersen, Søren Rasmussen, Lars Køber, Christian Torp-Pedersen

  Circulation. 08/2009;

  BACKGROUND: -Public-access defibrillation with automated external defibrillators (AEDs) is being implemented in many countries worldwide with considerable financial implications. The potentialBACKGROUND: -Public-access defibrillation with automated external defibrillators (AEDs) is being implemented in many countries worldwide with considerable financial implications. The potential benefit and economic consequences of focused or unfocused AED deployment are unknown. Methods and Results-All cardiac arrests in public in Copenhagen, Denmark, from 1994 through 2005 were geographically located, as were 104 public AEDs placed by local initiatives. In accordance with European Resuscitation Council and American Heart Association (AHA) guidelines, areas with a high incidence of cardiac arrests were defined as those with 1 cardiac arrest every 2 or 5 years, respectively. There were 1274 cardiac arrests in public locations. According to the European Resuscitation Council or AHA guidelines, AEDs needed to be deployed in 1.2% and 10.6% of the city area, providing coverage for 19.5% (n=249) and 66.8% (n=851) of all cardiac arrests, respectively. The excessive cost of such AED deployments was estimated to be $33 100 or $41 000 per additional quality-adjusted life year, whereas unguided AED placement covering the entire city had an estimated cost of $108 700 per quality-adjusted life year. Areas with major train stations (1.8 arrests every 5 years per area), large public squares, and pedestrianized areas (0.6 arrests every 5 years per area) were main predictors of frequent cardiac arrests. Conclusion-To achieve wide AED coverage, AEDs need to be more widely distributed than recommended by the European Resuscitation Council guidelines but consistent with the American Heart Association guidelines. Strategic placement of AEDs is pivotal for public-access defibrillation, whereas with unguided initiatives, AEDs are likely to be placed inappropriately.

• [Differences between hospitals in long-term survival after successfully resuscitated out-of-hospital cardiac arrest]

  Authors: Jesper Kjaergaard, John Bro-Jeppesen, Lars Simon Rasmussen, Søren Loumann Nielsen, Fredrik Folke, Freddy Lippert, Michael C Wanscher, Christian Hassager

  Ugeskrift for laeger. 07/2009; 171(26):2169-73.

  INTRODUCTION: There are substantial differences in long-term survival of patients resuscitated from out-of-hospital cardiac arrest, and the level of care during hospitalization may be a contributingINTRODUCTION: There are substantial differences in long-term survival of patients resuscitated from out-of-hospital cardiac arrest, and the level of care during hospitalization may be a contributing factor. The purpose of this study was to determine if a difference in long-term prognosis between hospitals could be detected in patients surviving cardiac arrest in Copenhagen. MATERIAL AND METHODS: The mobile emergency care unit attempted resuscitation in 1,098 patients with out-of-hospital cardiac arrest in the period 2002 to 2006, among whom return of spontaneous circulation occurred in 336 (30%) of the patients admitted to hospital. Survival was determined using the Central Population Registry through Statistics Denmark. RESULTS: Patients admitted to a tertiary facility were younger, more frequently male, they had more commonly ventricular fibrillation/pulseless ventricular tachycardia (VF/pVT) as their initial rhythm, and they had more frequently received bystander cardiopulmonary resuscitation. Survival at 4.6 years was 41% in patients admitted to the tertiary hospital and 10% in patients admitted to other hospitals, p < 0.0001. After adjustment for other known risk factors, patients admitted to other hospitals had a hazard ratio of 1.8 for death (95% confidence interval: 1,4-2,5) compared with patients admitted to a tertiary facility. CONCLUSION: The survival rate after out-of-hospital cardiac arrest was significantly higher in patients admitted to a tertiary facility than among patients admitted to less specialized hospitals. Further studies are needed to identify causal factors.

• Feasibility and safety of prehospital administration of bivalirudin in patients with ST-elevation myocardial infarction.

  Authors: Maria Sejersten, Søren Loumann Nielsen, Thomas Engstrøm, Erik Jørgensen, Peter Clemmensen

  The American journal of cardiology. 06/2009; 103(12):1635-40.

  The selective thrombin inhibitor bivalirudin with a provisional glycoprotein IIb/IIIa inhibitor (GPI) has been shown to be comparable to heparin plus GPI in the rates of ischemic events but toThe selective thrombin inhibitor bivalirudin with a provisional glycoprotein IIb/IIIa inhibitor (GPI) has been shown to be comparable to heparin plus GPI in the rates of ischemic events but to significantly reduce the risk of bleeding complications in patients with acute coronary syndromes. The aim of this preliminary study was to describe the feasibility and safety of a switch from prehospital administration of unfractionated heparin to bivalirudin in ST-elevation acute myocardial infarction (STEMI) patients referred for primary percutaneous coronary intervention. Patients with STEMI treated with a 1-mg/kg bivalirudin bolus in the ambulance followed by infusion during angiography/primary percutaneous coronary intervention were compared with a STEMI control group (from the preceding year) treated with 10,000 U unfractionated heparin in the ambulance followed by in-hospital treatment with a GPI. A total of 102 patients (59%) receiving bivalirudin and 72 receiving heparin were followed during hospitalization. The baseline characteristics and prehospital treatment times were comparable between the 2 groups. The thrombolysis in myocardial infarction flow before and after primary percutaneous coronary intervention was similar. Stents were used significantly more often in the heparin-treated patients (90% versus 76%; p = 0.04), with bailout GPI for those receiving bivalirudin occurring in 30% compared with 83% of those receiving heparin (p <0.001). Significant bleeding complications were seen in <10% of all patients undergoing angiography with no difference between groups. Bivalirudin was easy to administer in the prehospital setting and did not affect the prehospital run times. In conclusion, the results suggest that prehospital bivalirudin administration is as safe and effective as heparin in the treatment of patients with STEMI. Prehospital administration seemed to reduce the need for GPI.

• [Lifesaving prehospital interventions]

  Authors: Emilie Ramberg, Claus Skak, Søren Loumann Nielsen, Lars Simon Rasmussen

  Ugeskrift for laeger. 02/2009; 171(3):134-7.

  INTRODUCTION: The Mobile Emergency Care Unit (MECU) in Copenhagen provides prehospital healthcare for the citizens in the Capital Region in case of acute illness or accidents. The aim of this studyINTRODUCTION: The Mobile Emergency Care Unit (MECU) in Copenhagen provides prehospital healthcare for the citizens in the Capital Region in case of acute illness or accidents. The aim of this study was to describe the patients whose treatment was categorized by the MECU as lifesaving and to compare these with all other patients. MATERIAL AND METHODS: We analysed the MECU database contents and ambulance records from 2005 with emphasis on treatment and diagnosis. Data related to admission to hospital and 30-day survival were retrieved via the Central Population Registry. RESULTS: A total of 296 treatments were classified as lifesaving in 2005, corresponding to 4.3% of all patient contacts in 2005. The most frequent diagnoses were "opioid-poisoning" and cardiac arrest. The treatment given in those cases was lifesaving in 34% and 16%, respectively. This is significantly higher than in the cases of convulsions/unconsciousness and trauma where only 0.6% and 6% of the treatments were lifesaving, respectively. After 30 days, 60.4% of the patients who received lifesaving treatment were alive. We found considerable differences among the individual diagnoses regarding both the 30-day survival and the hospitalization frequency. CONCLUSION: Approximately 4% of patient contacts in 2005 were classified as lifesaving, they were most frequently related to opioid-poisoning and cardiac arrest. A total of 60% of the patients were alive 30 days after the intervention.

• Effect on treatment delay of prehospital teletransmission of 12-lead electrocardiogram to a cardiologist for immediate triage and direct referral of patients with ST-segment elevation acute myocardial infarction to primary percutaneous coronary intervention.

  Authors: Maria Sejersten, Martin Sillesen, Peter R Hansen, Søren Loumann Nielsen, Henrik Nielsen, Sven Trautner, David Hampton, Galen S Wagner, Peter Clemmensen

  The American journal of cardiology. 04/2008; 101(7):941-6.

  Prehospital electrocardiogram (ECG) transmission to hospitals was shown to reduce time to treatment in patients with acute myocardial infarction. However, new technologies allow transmission directlyPrehospital electrocardiogram (ECG) transmission to hospitals was shown to reduce time to treatment in patients with acute myocardial infarction. However, new technologies allow transmission directly to a mobile unit so an attending physician can respond irrespective of presence within or outside the hospital. The primary study purpose was to determine whether delays could be decreased in an urban area by transmitting a prehospital 12-lead ECG directly to the attending cardiologist's mobile telephone for rapid triage and transport to a primary percutaneous coronary intervention (PCI) center, bypassing local hospitals and emergency departments. A secondary purpose was to describe whether transport would be safe despite longer transport times. During a 2-year period, patients with acute nontraumatic chest pain had their prehospital ECG transmitted directly to a cardiologist's mobile telephone. Time to treatment was compared with historic controls. After ECG evaluation, 168 patients (30%) were referred directly for PCI, and 146 of these (87%) underwent emergent catheterization. In referred patients, median time from 911 call to PCI was significantly shorter than in the control group (74 vs 127 minutes; p <0.001). Accordingly, door-to-PCI time was 63 minutes shorter for referred patients versus controls (34 vs 97 minutes; p <0.001). During transport, 7 patients (4%) experienced ventricular fibrillation; 3 patients (2%), ventricular tachycardia; and 1 patient (0.5%), pulseless electrical activity, including 2 deaths (1%) caused by treatment-resistant arrhythmia. In conclusion, transmission of a prehospital 12-lead ECG directly to the attending cardiologist's mobile telephone decreased door-to-PCI time by >1 hour when patients were transported directly to PCI centers, bypassing local hospitals. Ambulance transport seems safe despite longer transport times.

• [How is out-of-hospital cardiac arrest dispatched?]

  Authors: Ole Pagh Mathiesen, Søren Loumann Nielsen, Lars Simon Rasmussen

  Ugeskrift for laeger. 04/2008; 170(14):1145-7.

  INTRODUCTION: In Denmark any person needing urgent medical help can dial 112 and get in contact with an alarm centre where a non-health educated operator assesses what kind of help is needed. AINTRODUCTION: In Denmark any person needing urgent medical help can dial 112 and get in contact with an alarm centre where a non-health educated operator assesses what kind of help is needed. A specific dispatch report (DR) is used if an ambulance is dispatched. We assessed which DRs were used for the Copenhagen Mobile Emergency Care Unit (MECU) in the case of out-of-hospital cardiac arrest. MATERIALS AND METHOD: All DRs for the MECU during 2000 to 2006 were analyzed and compared with the diagnosis recorded by the dispatched specialist in anaesthesiology after every case. We divided the DRs into five categories: ''cardiac arrest'', ''possible death'', ''unconscious'', ''heart attack'', and ''miscellaneous'' (consisting of 40 different DR categories). RESULTS: We found 52088 DRs, 2902 of which were diagnosed as cardiac arrest. 32% of these cardiac arrests were dispatched in accordance with this, while the DRs were different from cardiac arrest in 68%. ''Unconscious'' accounted for 21%. 41% of the cases with DR cardiac arrest could not be verified upon the arrival of the dispatched medical doctor. CONCLUSION: Only 32% of the cases with cardiac arrest had a correct DR. We suspect that some of the patients had an unrecognized cardiac arrest at the time of contact to the alarm centre. The current alarm system can presumably be improved. The alarm centre has a central role in such a quality improvement.

• Recombinant FVIIa decreases perioperative blood transfusion requirement in burn patients undergoing excision and skin grafting--results of a single centre pilot study.

  Authors: Pär Ingemar Johansson, Kirsten Eriksen, Søren Loumann Nielsen, Rasmus Rojkjaer, Bjarne Alsbjørn

  Burns : journal of the International Society for Burn Injuries. 07/2007; 33(4):435-40.

  BACKGROUND: Excision of burn wounds is frequently associated with a large volume of blood loss requiring allogeneic blood transfusion. We conducted a pilot study to investigate the effect ofBACKGROUND: Excision of burn wounds is frequently associated with a large volume of blood loss requiring allogeneic blood transfusion. We conducted a pilot study to investigate the effect of activated recombinant coagulation factor VII (rFVIIa) on the reduction of blood transfusion requirements in burn patients undergoing excision and skin grafting. METHODS: Eighteen consecutive patients scheduled for the surgery were randomised to receive either placebo or 40 microg/kg rFVIIa administered at first skin incision, and a second dose (40 microg/kg) at 90 min later. Blood transfusion requirements during, and up to 24h post-surgery per patient and percentage full thickness wound excised were compared. In addition, postoperative complications commonly seen in patients with burns as well as adverse events related to rFVIIa were monitored. RESULTS: rFVIIa significantly decreased the total number of units of blood components transfused per patient and percentage full thickness burn wound excised compared with placebo (0.9 versus 2.2, p=0.0013) including significant fewer red blood cell units (0.5 versus 1.1, p=0.004). We further observed a trend towards improved graft survival (p=0.1) and a reduction in multiple organ failures (p=0.08) in the rFVIIa-treated group. There were no adverse events, in particular thromboembolic events. CONCLUSION: rFVIIa might be useful in decreasing blood transfusion requirements in burn patients undergoing excision and skin grafting.

• [Patients' satisfaction with the Mobile Emergency Care Unit in Copenhagen]

  Authors: Ulf Gøttrup Pedersen, Susanne Jørgensen, Søren Loumann Nielsen

  Ugeskrift for laeger. 10/2006; 168(39):3322-5.

  INTRODUCTION: Patients' satisfaction with physician-staffed ambulances in Copenhagen had not previously been investigated. We therefore conducted a survey of patients' satisfaction with the MobileINTRODUCTION: Patients' satisfaction with physician-staffed ambulances in Copenhagen had not previously been investigated. We therefore conducted a survey of patients' satisfaction with the Mobile Emergency Care Unit (MECU) in Copenhagen. MATERIALS AND METHODS: The period of investigation was from 1 September 2003 to 31 December 2003. Patients with a diagnosis of COPD, asthma or a cardiac disease were eligible for inclusion. Patients were excluded if they had not yet been discharged from hospital, were registered as deceased, were under the age of 18, were without a known address or had previously been included. RESULTS: During the period of investigation, 282 questionnaires were sent out; 225 were returned, for a response rate of 80%. The patients' mean age was 71 (18-99 years). On the part of 96% of the patients, the general impression of the MECU was very good or good, and 85% felt more confident when being treated by a physician in addition to the regular ambulance crew. The majority (80%) felt that the information given by the physician had been good, and 90% that the conduct of the physician had been satisfactory or better. In 11 questionnaires the patients, in their own words, described dissatisfaction with part of the MECU. In seven cases this concerned the conduct of or the information given by the ambulance crew. Most of the patients and physicians felt that the efforts of the MECU had improved the patient's condition. CONCLUSION: We conclude that in general patients are satisfied with the service provided by the MECU. They are aware of, and feel more confident when being treated by, a physician in addition to the regular ambulance crew. Reasons for dissatisfaction were the conduct of and the information given by the physician.

• [Intraosseous access in adults--an alternative if conventional vascular access is difficult?]

  Authors: Dan Lou Isbye, Søren Loumann Nielsen

  Ugeskrift for laeger. 09/2006; 168(34):2793-7.

  Intraosseous infusion is widely used in children, but its use in adults is much less common. This is probably because another vascular access can usually be achieved, and also because of lack ofIntraosseous infusion is widely used in children, but its use in adults is much less common. This is probably because another vascular access can usually be achieved, and also because of lack of knowledge of the technique. Placement in adults is a quick procedure with a high rate of success. Drugs and fluids do not change the pharmacodynamics or pharmacokinetics of intraosseous administration, and anything can be given. Infusion rates have been achieved that in part make fluid resuscitation possible. Its uses are many and the contraindications few; complications are rare when simple guidelines are followed.

• [Telemedicine in the transmission of prehospitalisation ECGs of patients with suspected acute myocardial infarction]

  Authors: Martin Sillesen, Maria Sejersten Ripa, Søren Strange, Søren Loumann Nielsen, Erik Jørgensen, Freddy K Lippert, Peter Michael Clemmensen

  Ugeskrift for laeger. 03/2006; 168(11):1133-6.

  INTRODUCTION: Time to reperfusion is critical to the outcome of patients with ST-elevation myocardial infarction (MI). Other studies have indicated that wireless transmission of prehospital ECGs canINTRODUCTION: Time to reperfusion is critical to the outcome of patients with ST-elevation myocardial infarction (MI). Other studies have indicated that wireless transmission of prehospital ECGs can reduce the time to reperfusion. This study evaluated the effect on time to treatment using prehospitalisation ECG transmission to a cardiologist's handheld device in patients with acute chest pain, as well as the potential effect of direct transfer of patients to the closest appropriate cardiological facility. MATERIALS AND METHODS: During a one-year study period, prehospitalisation ECGs were transmitted for all patients with symptoms indicative of acute coronary syndrome. The ECGs were received on a handheld device by an attending cardiologist, and the patient was referred to PCI treatment if ST-elevation was found. RESULTS: 152 transmissions were registered; 27 of these patients underwent primary PCI treatment. 135 (89%) of the attempted transmissions were successful. Compared to historic controls, there was an increased on-scene time usage of 7 minutes, including transfer. The median time spent from arrival at the hospital to the start of invasive treatment was low, 22 minutes. Compared to historic controls, we found a total reduction in time spent of 72 minutes (p< 0.01). DISCUSSION: The results indicate that it is possible to minimize the time delay to primary PCI treatment by direct transfer through consultation and use of wireless transmission of prehospitalisation-acquired ECGs to a handheld device carried by an attending cardiologist.

• Diversion of ST-elevation myocardial infarction patients for primary angioplasty based on wireless prehospital 12-lead electrocardiographic transmission directly to the cardiologist's handheld computer: a progress report.

  Authors: Peter Clemmensen, Maria Sejersten, Martin Sillesen, David Hampton, Galen S Wagner, Søren Loumann Nielsen

  Journal of electrocardiology. 11/2005; 38(4 Suppl):194-8.

  BACKGROUND: Time to reperfusion is critical for outcome in patients with ST-elevation myocardial infarction (STEMI). In our region, patients are routinely treated by primary percutaneous coronaryBACKGROUND: Time to reperfusion is critical for outcome in patients with ST-elevation myocardial infarction (STEMI). In our region, patients are routinely treated by primary percutaneous coronary intervention (pPCI), but rerouting patients from the primary receiving hospital to a catheterization center can cause unacceptable delays that may exceed 1 hour in the emergency department. Wireless transmission of prehospital electrocardiograms (ECGs) to receiving stations in hospitals has been shown to reduce time from symptom onset to reperfusion. However, transmission directly to a cardiologist's handheld digital device has not been investigated. AIM: To report preliminary data from a larger ongoing trial evaluating prehospital 12-lead ECG transmission to a cardiologist's handheld device in patients with symptoms suggesting an acute coronary syndrome. METHOD: Patients suffering acute, nontraumatic chest pain have their prehospital ECG transmitted by wireless technology directly to a cardiologist's handheld device at an invasive hospital, allowing diversion of STEMI cases to rapid pPCI. Transmission failures are documented. Times for symptom onset, 911 alert, ECG recording, hospital arrival, and pPCI are obtained. All time intervals are summarized as median values and are compared with historic controls from the Danish multicenter study, DANAMI-2. RESULTS: During the first 15 months of the trial, prehospital ECGs were transmitted for 408 chest pain patients with an overall success rate of 93%. Cardiologist receiving the ECGs recommended that 113 patients (28%) be diverted for pPCI. Mean time from symptom onset to 911 alert was 2 hours 16 minutes (range, 1 minute to 23 hours 15 minutes), and the ambulance response interval was 5 minutes (range, 1-25 minutes). The ambulance on-scene time had increased by 7 minutes compared with historic controls (P<.05). Time from ECG recording to hospital arrival was 25 minutes. The total prehospital time was 2 hours 57 minutes. The hospital treatment time was substantially reduced among diverted patients. Hospital arrival to procedure start was 40 minutes, compared with 94 minutes in the DANAMI-2 historic control group (P<.01). CONCLUSION: These preliminary data suggest that transmission of prehospital 12-lead ECGs directly to the attending cardiologist using handheld devices is a technologically sound concept without major safety concerns and markedly reducing time to reperfusion in patients with STEMI.

• [Research on prehospital and emergency care--a necessity with difficult conditions]

  Authors: Søren Loumann Nielsen, Freddy K Lippert

  Ugeskrift for laeger. 12/2003; 165(45):4283.

• Referral of patients with ST-segment elevation acute myocardial infarction directly to the catheterization suite based on prehospital teletransmission of 12-lead electrocardiogram.

  Authors: Martin Sillesen, Maria Sejersten, Søren Strange, Søren Loumann Nielsen, Freddy Lippert, Peter Clemmensen

  Journal of electrocardiology. 41(1):49-53.

  BACKGROUND: Time from symptom onset to reperfusion is essential in patients with ST-segment elevation acute myocardial infarction. Prior studies have indicated that prehospital 12-leadBACKGROUND: Time from symptom onset to reperfusion is essential in patients with ST-segment elevation acute myocardial infarction. Prior studies have indicated that prehospital 12-lead electrocardiogram (ECG) transmission can reduce time to reperfusion. PURPOSE: Determine 12-lead ECG transmission success rates, and time saved by referring patients directly to primary percutaneous coronary intervention (pPCI) bypassing local hospitals and emergency departments. METHODS: Prehospital 12-lead ECG was recorded in patients with symptoms suggesting acute coronary syndrome during a 1-year pilot phase and transmitted to the attending cardiologist's mobile phone. Transmission success rates were determined, and prehospital and hospital delays were recorded and compared to historic controls. RESULTS: Transmission was attempted in 152 patients and was successful in 89%. Twenty-seven patients were referred directly for pPCI. Median hospital arrival to pPCI was 22 vs 94 minutes in the control group (P < .01). CONCLUSIONS: Transmission of prehospital ECG is technically feasible and reduces time to pPCI in ST-segment elevation acute myocardial infarction patients.

• Telemedicine fighting acute coronary syndromes.

  Authors: Peter Clemmensen, Søren Loumann-Nielsen, Maria Sejersten

  Journal of electrocardiology. 43(6):615-8.

  Telemedicine allows exchange of information and has therefore become an important tool for optimizing patient treatment in the field of cardiology. Transmission of electrocardiograms (ECGs) from theTelemedicine allows exchange of information and has therefore become an important tool for optimizing patient treatment in the field of cardiology. Transmission of electrocardiograms (ECGs) from the prehospital setting to the receiving hospital is the most widespread technology in the prehospital setting. Providing a diagnostic ECG from patients with acute coronary syndromes to health care professionals with decision-making power has proven pivotal for an early diagnosis, ideal triage, and initiation of reperfusion therapy of the large group of patients presenting with ST-elevation myocardial infarction (STEMI). This urgent triage could be expanded to several diagnosis in cardiology, primarily the non-ST-elevation presenters. The purpose of the present article is to briefly describe the history the teletransmitted ECG and some of the recent results obtained when used in routine practice for acute triage and referral for primary percutaneous coronary intervention. Transmitting 12-lead ECGs from the community directly to attending cardiologists should become routine. Time to reperfusion in STEMI has decreased, explaining much of the observed decrease in STEMI mortality. This technology allows for increasingly complex and individualized prehospital medical care and could be expanded to a broader number of cardiovascular diagnoses.