Mobile Cloud-Based 12-Lead ECG Transmission during Helicopter Transport of STElevation Myocardial Infarction Patients

Author(s): Makoto Onodera, Tomotaka Misawa, Kotaro Sorimachi, Ken Iseki, Takeshi Shimizu, Takayoshi Yamaki, Yasuchika Takeishi, Keiji Sakamoto, Hiroki Hosaka, Hiroyuki Mizukami, Masahiro Ono

Delayed reperfusion therapy for ST-segment elevation myocardial infarction (STEMI) is associated with high mortality rates. Although mobile cloud-based 12-lead electrocardiogram (MC-ECG) systems have shown promise in reducing treatment delays, their implementation remains limited in regions where geographic and institutional constraints hinder timely interventions. This study aimed to evaluate the effectiveness of helicopter emergency medical services (HEMS) equipped with an MCECG system in reducing the time to reperfusion and improving shortterm outcomes in patients with STEMI. This retrospective observational study included patients with STEMI transported via HEMS in Fukushima Prefecture between July 2022 and August 2024. The inclusion criterion was confirmation of ST elevation by a flight physician using MC-ECG at rendezvous points (RPs) with subsequent percutaneous coronary intervention (PCI) at a receiving facility. The measured outcomes included the time from symptom onset to emergency medical service contact, contact with the flight physician, transport times, door-to-balloon time (DTBT), and 30-day survival. Among the 1,087 HEMS dispatches, 15 STEMI cases met the inclusion criteria. The median patient age was 59 years, and 80% of the patients were men. The median DTBT was 57 min and the 30-day survival rate was 100%. Air transport was significantly faster than predicted ground transport (median 12 vs. 61 min, p < 0.01). The integration of MC-ECG into the HEMS enabled the rapid diagnosis and transport of patients with STEMI to PCI-capable facilities, achieving DTBT within guideline-recommended timeframes and excellent short-term outcomes. This approach may be particularly beneficial in geographically dispersed regions with limited cardiological resources.