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New PC slide - Promedica International · –ECG only listed by Date, Time, EMS provider –Treat...

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YES: We need ECG Transmission to optimize STEMI Efficiency Ivan C. Rokos, MD, FACEP, FAHA, (FACC) Emergency Physician Asst. Clinical Professor, UCLA Staff Physician, Olive View-UCLA Staff Physician, Northridge Hospital Los Angeles, CA **No financial Disclosures**
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Page 1: New PC slide - Promedica International · –ECG only listed by Date, Time, EMS provider –Treat CCL activation, not the patient directly –Cloud only stores ECG within last 2 hours

YES: We need ECG Transmission to

optimize STEMI Efficiency

Ivan C. Rokos, MD, FACEP, FAHA, (FACC)

Emergency Physician

Asst. Clinical Professor, UCLA

Staff Physician, Olive View-UCLA

Staff Physician, Northridge Hospital

Los Angeles, CA

**No financial Disclosures**

Page 2: New PC slide - Promedica International · –ECG only listed by Date, Time, EMS provider –Treat CCL activation, not the patient directly –Cloud only stores ECG within last 2 hours

D2B Alliance

Tier-I strategies

1. ED physician activates the cath lab

– The 90-10 caveat to maintain credibility

2. One call activates the cath lab

3. Cath lab team ready in 20-30 minutes

4. Prompt data feedback

5. Senior management commitment

6. Team-based approach

Optional = Pre-hospital ECG to activate the Cath Lab

Page 3: New PC slide - Promedica International · –ECG only listed by Date, Time, EMS provider –Treat CCL activation, not the patient directly –Cloud only stores ECG within last 2 hours

PROBLEM

Page 4: New PC slide - Promedica International · –ECG only listed by Date, Time, EMS provider –Treat CCL activation, not the patient directly –Cloud only stores ECG within last 2 hours
Page 5: New PC slide - Promedica International · –ECG only listed by Date, Time, EMS provider –Treat CCL activation, not the patient directly –Cloud only stores ECG within last 2 hours
Page 6: New PC slide - Promedica International · –ECG only listed by Date, Time, EMS provider –Treat CCL activation, not the patient directly –Cloud only stores ECG within last 2 hours

SOLUTION #1

Page 7: New PC slide - Promedica International · –ECG only listed by Date, Time, EMS provider –Treat CCL activation, not the patient directly –Cloud only stores ECG within last 2 hours

2 New Efficiency Metrics (Lange et al, Interventional Cardio Clinic 2016, 5:451)

• Activation Index (>95%)

– # Angiograms for every 100 CCL Activations

• Revascularization Index (80-90%)

– # PPCI for every 100 Angiograms

• Key Point: Measure Objective Events

– STEMI system Efficiency judged by rate of

Emergency Coronary Angiograms, not PPCI

Page 8: New PC slide - Promedica International · –ECG only listed by Date, Time, EMS provider –Treat CCL activation, not the patient directly –Cloud only stores ECG within last 2 hours

SOLUTION or

PROBLEM?

Pre-ACT Algorithm from MLL

Page 9: New PC slide - Promedica International · –ECG only listed by Date, Time, EMS provider –Treat CCL activation, not the patient directly –Cloud only stores ECG within last 2 hours

p

Page 10: New PC slide - Promedica International · –ECG only listed by Date, Time, EMS provider –Treat CCL activation, not the patient directly –Cloud only stores ECG within last 2 hours

Pre-ACT algorithm

Page 11: New PC slide - Promedica International · –ECG only listed by Date, Time, EMS provider –Treat CCL activation, not the patient directly –Cloud only stores ECG within last 2 hours

The Major Flaw of Pre-ACT

• Accurate STEMI diagnosis needs an IMAGE,

not an Impression

– Consider STE-mimics or ECG artifacts

• Cardiology is Image-intensive:

– Define the Anatomy with an IMAGE prior to

• PCI

• TAVR

• TMVR, etc.

• And CCL Team Activation

Page 12: New PC slide - Promedica International · –ECG only listed by Date, Time, EMS provider –Treat CCL activation, not the patient directly –Cloud only stores ECG within last 2 hours

SOLUTION #2

Page 13: New PC slide - Promedica International · –ECG only listed by Date, Time, EMS provider –Treat CCL activation, not the patient directly –Cloud only stores ECG within last 2 hours

“WhatsApp” ECG Transmission (Argentine Congress of Cardiology per TCTMD Oct-27-17)

• N= 900 STEMI in Buenos Aires

• 360 patients with successful Transmit

– ED Bypass, so EMS direct to CCL

– Shorter Symptom-Device time (150 vs. 200min)

– Better LVEF (51% vs. 48%)

– Shorter hospital stay (4.9 vs. 5.6 days)

– Lower mortality (0.8% vs. 3.2%)

• Drawbacks: photo of ECG, needs mobile#

Page 14: New PC slide - Promedica International · –ECG only listed by Date, Time, EMS provider –Treat CCL activation, not the patient directly –Cloud only stores ECG within last 2 hours

SOLUTION #3

Even Better than WhatsApp.

Page 15: New PC slide - Promedica International · –ECG only listed by Date, Time, EMS provider –Treat CCL activation, not the patient directly –Cloud only stores ECG within last 2 hours

Instantly Auto-Transmit any

ECG with STEMI

Page 16: New PC slide - Promedica International · –ECG only listed by Date, Time, EMS provider –Treat CCL activation, not the patient directly –Cloud only stores ECG within last 2 hours

Cloud & App idea

Page 17: New PC slide - Promedica International · –ECG only listed by Date, Time, EMS provider –Treat CCL activation, not the patient directly –Cloud only stores ECG within last 2 hours

The Feds: Any Restrictions?

• HIPAA compliant Cloud & App

– ECG only listed by Date, Time, EMS provider

– Treat CCL activation, not the patient directly

– Cloud only stores ECG within last 2 hours

• FDA has De-Regulated transmission

– Per Congress “21st Century Cures Act, #3060”

– Digital PDF image same as Paper print-out from device

• FDA Delay: Repeat PMA process for AED – PH-ECG & Defibrillator device innovation remains frozen

– Frustration with Innovation due to Regulation

Page 18: New PC slide - Promedica International · –ECG only listed by Date, Time, EMS provider –Treat CCL activation, not the patient directly –Cloud only stores ECG within last 2 hours

Conclusions

• STEMI Systems need to Mature

– Adolescence: Fast & Foolish

– Adult: Fast & Filter for true STEMI

• “Trust but Verify” via smartphones

• ECG transmit is Essential in modern era

– Automatic, Instant, and Globally Reliable

– Easy for any clinician to view on Smartphone

Page 19: New PC slide - Promedica International · –ECG only listed by Date, Time, EMS provider –Treat CCL activation, not the patient directly –Cloud only stores ECG within last 2 hours

Innovation SOLUTION?

Persistent Problem?


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