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**
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
PROBLEM
SOLUTION #1
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
SOLUTION or
PROBLEM?
Pre-ACT Algorithm from MLL
p
Pre-ACT algorithm
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
SOLUTION #2
“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#
SOLUTION #3
Even Better than WhatsApp.
Instantly Auto-Transmit any
ECG with STEMI
Cloud & App idea
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
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
Innovation SOLUTION?
Persistent Problem?
