Subscribe to RSS
DOI: 10.1055/s-0042-103426
Telemedizin aus dem Notarztwagen verbessert die Versorgungsstruktur bei Herzinfarkt
Telemedicine at First Medical Contact Improves Outcome in ST-segment Myocardial InfarctionPublication History
Publication Date:
21 April 2016 (online)
![](https://www.thieme-connect.de/media/aktkardio/201602/lookinside/thumbnails/10-1055-s-0042-103426_ka060-1.jpg)
Zusammenfassung
Die Nutzung der EKG-Telemetrie führt zu einer verbesserten Herzinfarktversorgung [17], [18]. Nur durch eine flächendeckende Etablierung von Herzinfarktnetzen, die qualitätsmäßig überwacht und mit telemetriebasierten Behandlungspfaden ausgestattet sind, kann eine weitere Senkung der Mortalität bei Patienten mit akutem STEMI erreichten werden. Um das Ziel einer flächendeckenden Telemetriemöglichkeit zu gewährleisten, ist auch von den Kostenträgern eine entsprechende Unterstützung gefordert. Die Grundbausteine der Telemedizin aus dem Notarztwagen sind somit vorhandene verlässliche Technik, funktionierende Algorithmen und eine hohe Akzeptanz durch die Beteiligten. Das Erreichte muss durch regelmäßige Feedback-Veranstaltungen und Schulungsmaßnahmen permanent reevaluiert und ggf. angepasst werden.
Abstract
The use of ECG-transmission of patients with STEMI to the cardiology intervention center at first medical contact shortens door-to-balloon times, reduces infarct size, limits ejection fraction reduction and shortens length of hospital stay. Network organization is recommended for optimal STEMI management to offer primary percutaneous intervention (PCI) to the maximum proportion of patients within the recommended time spans. As ECG diagnosis alone lacks on sensitivity and specificity an additional phone contact between EMS (emergency medical system) and interventional center may be recommended. High technical standards as well as acceptance of treatment guidelines in a network organization are prerequisites for successful use of telemedicine. Delays to treatment are the most readily available measurable index of quality of care in STEMI and have to be monitored regularly to ensure that quality of care indicators are met and maintained over time.
-
Literatur
- 1 Maier SKG, Thiele H, Zahn R et al. Empfehlung zur Organisation von Herzinfarktnetzwerken. Kardiologie 2014; 8: 36-44
- 2 Scholz KH, Hilgers R, Ahlersmann D et al. Contact-to-balloon time and door-to-balloon time after initiation of a formalized data feedback in patients with acute ST-elevation myocardial infarction. Am J Cardiol 2008; 101: 46-52
- 3 Sefrin P, Lafontaine B. Prehospital treatment of the acute coronary syndrome in the emergency medical services in Bavaria. Dtsch Med Wochenschr 2004; 129: 2025-2031
- 4 Task Force on the management of ST-segment elevation acute myocardial infarction of the European Society of Cardiology (ESC), Steg PG, James SK, Atar D et al. ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation. Eur Heart J 2012; 33: 2569-2619
- 5 Huber K, Gersh BJ, Goldstein P et al. The organization, function, and outcomes of ST-elevation myocardial infarction networks worldwide: current state, unmet needs and future directions. Eur Heart J 2014; 35: 1526-1532
- 6 McCabe JM, Armstrong EJ, Ku I et al. Physician accuracy in interpreting potential ST-segment elevation myocardial infarction electrocardiograms. J Am Heart Assoc 2013; 2: e000268
- 7 Sefrin P, Maier S. [Study Group of the Bavarian Heart Attack Network: Preclinical Standards in the Treatment of Heart Attack]. Der Notarzt 2011; 27: 101-104
- 8 Scholz KH, Maier SK, Jung J et al. Reduction in treatment times through formalized data feedback: results from a prospective multicenter study of ST-segment elevation myocardial infarction. JACC Cardiovasc Interv 2012; 5: 848-857
- 9 Scholz KH, Maier SK, Jung J et al. Umgehung der Notaufnahme führt zu erheblicher Verkürzung der Revaskularisationszeiten und besserer Prognose bei STEMI-Patienten – Ergebnisse aus dem FITT-STEMI-Gesamtprojekt. Clin Res Cardiol 2011; 100 (Suppl. 01) P1643
- 10 Kolte D, Khera S, Dabhadkar KC et al. Trends in Coronary Angiography, Revascularization, and Outcomes of Cardiogenic Shock Complicating Non-ST-Elevation Myocardial Infarction. Am J Cardiol 2016; 117: 1-9
- 11 Roffi M, Patrono C, Collet JP et al. 2015 ESC guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: Task Force for the Management of Acute Coronary Syndromes in Patients Presenting without Persistent ST-Segment Elevation of the European Society of Cardiology (ESC). European Heart Journal 2016; 37: 267-315
- 12 Schwarz B, Abdel-Wahab M, Robinson DR et al. Predictors of mortality in patients with cardiogenic shock treated with primary percutaneous coronary intervention and intra-aortic balloon counterpulsation. Med Klin Intensivmed Notfmed 2015; [Epub ahead of print]
- 13 Garvey JL, Monk L, Granger CB et al. Rates of cardiac catheterization cancelation for ST-segment elevation myocardial infarction after activation by emergency medical services or emergency physicians: results from the North Carolina Catheterization Laboratory Activation Registry. Circulation 2012; 125: 308-313
- 14 Menees DS, Peterson ED, Wang Y et al. Door-to-balloon time and mortality among patients undergoing primary PCI. N Engl J Med 2013; 369: 901-909
- 15 Nicolai T. Einfluss der EKG-Telemetrie auf die strukturellen Abläufe im Herzinfarktnetz Mainfranken bei der Versorgung von Patienten mit ST-Streckenhebungsmyokardinfarkt (STEMI) [Inaugal-Dissertation]. Universität Würzburg; 2013
- 16 McNamara RL, Wang Y, Herrin J et al. Effect of door-to-balloon time on mortality in patients with ST-segment elevation myocardial infarction. J Am Coll Cardiol 2006; 47: 2180-2186
- 17 Brunetti ND, Bisceglia L, Dellegrottaglie G et al. Lower mortality with pre-hospital electrocardiogram triage by telemedicine support in high risk acute myocardial infarction treated with primary angioplasty: Preliminary data from the Bari-BAT public Emergency Medical Service 118 registry. Int J Cardiol 2015; 185: 224-228
- 18 Sanchez-Ross M, Oghlakian G, Maher J et al. The STAT-MI (ST-Segment Analysis Using Wireless Technology in Acute Myocardial Infarction) Trial Improve Outcomes. J AM Coll Cardiol Intv 2011; 4: 222-227