Article Text
Abstract
Introduction Use of the prehospital 12-lead ECG (PHECG) is recommended in patients presenting to emergency medical services (EMS) with suspected acute coronary syndrome (ACS). Prior research found that although PHECG use was associated with improved 30-day survival, a third of patients (typically women, the elderly and those with comorbidities) under EMS care did not receive a PHECG.
The overall aim of the PHECG2 study is to update evidence on care and outcomes for patients eligible for PHECG, specifically addressing the following research questions: (1) Is there a difference in 30-day mortality, and in reperfusion rate, between those who do and those who do not receive PHECG? (2) Has the proportion of eligible patients who receive PHECG changed since the introduction of primary percutaneous coronary intervention networks? (3) Are patients that receive PHECG different from those that do not in terms of social and demographic factors, or prehospital clinical presentation? (4) What factors influence EMS clinicians’ decisions to perform PHECG?
Methods and analysis This is an explanatory, mixed-method study comprising four work packages (WPs). WP1 is a population-based, linked-data analysis of a national ACS registry (Myocardial Ischaemia National Audit Project). WP2 is a retrospective chart review of patient records from three large regional EMS. WP3 comprises focus groups of EMS personnel. WP4 will synthesise findings from WP1–3 to inform the development of an intervention to increase PHECG uptake.
Ethics and dissemination The study has been approved by the London-Hampstead Research Ethics Committee (ref: 18LO1679). Findings will be disseminated through feedback to participating EMS, conference presentations and publication in peer-reviewed journals.
Trial registration number NCT03699137
- 12 lead ECG
- acute coronary syndrome
- quality of care and outcomes
- emergency medicine
This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.
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Footnotes
Twitter @proftomquinn
Contributors TQ conceived the study idea, led the funding application and protocol development and takes overall responsibility for all aspects of the study as chief investigator. LG contributed to protocol development and funding application, is project manager for the whole study, coordinated regulator and ethical approval processes, and leads WP2. MH contributed to protocol development and funding application, and leads WP3. AW contributed to protocol development and supported TD with development of the study database, and plans for quantitative data management and statistical analysis. HS contributed to protocol development and funding application, and leads WP4. GD reviewed the protocol and provided feedback from the patient and public perspective. CPG and CW contributed to protocol development and provided expert cardiovascular advice, together with specific expertise on analysis of MINAP data. AR, NR, SB, SM and CH contributed to protocol development and provided expert advice on EMS practice. All authors have read and approved the final version of the manuscript.
Funding This work is supported by British Heart Foundation; grant number PG/18/13/33558.
Competing interests CW is clinical lead for MINAP. CPG and TQ are members of the MINAP domain expert
group within NICOR.
Patient consent for publication Not required.
Ethics approval London-Hampstead REC 18/LO/1679.
Provenance and peer review Not commissioned; externally peer reviewed.
Data availability statement Data may be obtained from a third party and are not publicly available.