Article
Skill evaluation to identify educational needs: Which ECG patterns prompt paramedics to identify the need for PPCI – a pilot study
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Authors
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Philipp Weingartshofer
- Österreichisches Rotes Kreuz, Landesverband Niederösterreich, Bildung Einsatzdienste, Tulln, Austria
| Published: | May 27, 2024 |
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Outline
Text
Background: In Lower Austria, Ambulance calls with ACS-like symptoms, but with no evidence for vital sign abnormalities are attended by ALS ambulances. Therefore, it is vital that paramedics can identify the patients with STEMI or ECG patterns that should be treated like STEMI. To identify educational needs the education department of the ambulance provider undertook a pilot study to evaluate the ability of ALS paramed-ics to identify the need for primary percutaneous coronary intervention (PPCI).
Methods: A prospective single-blinded observational study asking Austrian ALS paramedics to fill out a questionnaire containing 12 ECGs. Some of the ECG patterns have recent-ly been declared as “very high risk” by the European Society for Cardiology (ESC). Participants had to tick whether the patient needs immediate transport to a PCI centre or not.
Results: 72 Austrian ALS paramedics participated in the study. Correct positive answers varied between 100% (STEMI) and 47% (De Winter and Wellens signs). The recently declared “very high risk” ECG patterns were correctly identified between 88% (left bundle branch block with Sgarbossa criteria) and 47% (De Winter and Wellens signs). However, false positive answers varied between 11% (normal sinus rhythm) and 54% (unspecific ST-segment changes).
Conclusion: The methodology proved to deliver statistically significant results. The participants can apply the traditional concept of STEMI with 99% to 100% accuracy. The new ESC “very high risk” ECGs that do not present themselves with ST-elevation (De Winter, Wellens sign) trigger only 47% correct decisions. Also, false positive an-swers are up to 54% (unspecific ST-segment changes) but even a normal sinus rhythm triggered 11% respectively 19 % of participants to believe in PPCI indication.
In any case, further education is needed with focus on identifying De Winter and Wellens sign as very high-risk ECG patterns and reduce false positive decisions especially on ECGs with unspecific ST-segment changes.
As the methodology proved to be suitable, follow-up research can be undertaken with the same methods but should focus on data collection through a representative sample of paramedics.
