The American journal of emergency medicine
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Multicenter Study Clinical Trial
Sharing and Teaching Electrocardiograms to Minimize Infarction (STEMI): reducing diagnostic time for acute coronary occlusion in the emergency department.
Limits to ST-Elevation Myocardial Infarction (STEMI) criteria may lead to prolonged diagnostic time for acute coronary occlusion. We aimed to reduce ECG-to-Activation (ETA) time through audit and feedback on STEMI-equivalents and subtle occlusions, without increasing Code STEMIs without culprit lesions. ⋯ There were 51 culprit lesions in the baseline period, and 64 in the intervention period. Median ETA declined from 28.0 min (95% confidence interval [CI] 15.0-45.0) to 8.0 min (95%CI 6.0-15.0). The website garnered 70.4 views/week and 27.7 visitors/week in a group of 80 physicians. There was no change in percentage of Code STEMIs without culprit lesions: 28.2% (95%CI 17.8-38.6) to 20.0% (95%CI 11.2-28.8%). Conclusions Our novel weekly web-based feedback to all emergency physicians was associated with a reduction in ETA time by 20 min, without increasing Code STEMIs without culprit lesions. Local ECG audit and feedback, guided by ETA as a quality metric for acute coronary occlusion, could be replicated in other settings to improve care.
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Multicenter Study Observational Study
Can bystanders' gender affect the clinical outcome of out-of-hospital cardiac arrest: A prospective, multicentre observational study.
Out-of-hospital cardiac arrest (OHCA) is one of the most common causes of death in many countries. For OHCA patients to have a good clinical outcome, bystander cardiopulmonary resuscitation (CPR) is extremely significant. It is necessary to study the various characteristics of bystanders to improve bystander CPR quality. We aimed to evaluate the correlation between bystanders' gender and clinical outcomes of patients with OHCA. ⋯ There was no difference in the neurologic outcomes of OHCA patients based on bystanders' gender. However, according to subgroup analysis, there was a difference in the neurologic outcome depending on the status of bystanders' CPR education and females received less CPR education than males. Therefore, more active CPR education is required.