UCONN Emergency Medicine Interest Group

Posts Tagged ‘Andrew Cathers’

Journal Article Synopsis: Prewired Electrodes for ECG

In JOURNAL CLUB on May 11, 2011 at 5:42 PM

Summary for “Comparison of the Use of Conventional and Prewired Electrodes for Electrocardiography in an Emergency Setting: The Spaghetti Study” by Frederic Lapostolle et al. in Annals of Emergency Medicine Vol 57 (4); pp 357 -361

What is already known on this topic:
ECG’s are a routine procedure commonly encountered in the Emergency Department and integral to the diagnosis and disposition of a wide variety of patients. The two most important factors in the usefulness of an ECG are its quality and the duration of time it takes to be performed. A poorly done ECG done promptly can be just as useless as a well-done ECG received too late. Therefore, improvements in the speed and quality of ECG recording are highly sought after.

The quality and promptness of an ECG are heavily influenced by the user. It is not uncommon for errors to occur in the placement of ECG leads, in particular reversal of the leads. These types of mistakes can lead to a significant loss in time and accuracy of interpretation of ECG’s. Unfortunately, these types of errors are more common in the acute settings, such as those often seen in Emergency Departments. This study involved the use of pre-wired electrodes, rather than conventional electrodes that are placed and then hooked up to the series of wires. These prewired electrodes are disposable, pre-wired, pre-gelled, and numbered for ease and elimination of ambiguity in placement.

What questions this study addressed:
Is there a difference in the quality of ECG recordings obtained with conventional versus prewired electrodes ? How easy is the use of the prewired electrodes in an emergency setting?

What was the study design:
Prospective, randomized, open comparison study including 105 patients undergoing ECG’s. Time to make recordings was measured, and both a prewired and conventional recording was performed. These were then analyzed and scored by 3 blinded reviewers, on the basis of artifacts and baseline instability.

What this study adds to our knowledge:
The ECG’s performed with the prewired electrodes took 20% less time than those done with conventional electrodes (average 118 seconds versus 144 seconds). Signal noise and baseline instability were significantly reduced with prewired electrodes regardless of the endpoint considered (whether number of unstable leads, max signal noise, baseline instability score, etc). There was no significant difference found in the prevalence of p-wave or QRS complex abnormalities.

How this is relevant to clinical practice:
The recordings done with prewired electrodes were accomplished significantly faster than those with conventional – and this did not include the time necessary to disinfect and untangle the lead wires (a daunting task, at times). In addition, recordings with prewired electrodes were significantly better than those made with conventional electrodes. The number of artifact-free recordings was nearly twice as high, and the level of signal noise and baseline instability was significantly lower.

Other considerations:
It would be interesting to examine this from a cost-benefit perspective. Although prewired electrodes are faster and provide better recordings, they are also more expensive – would they pay for themselves with faster and better quality care?

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