Paramedic PapersHome Topics Cardiac (non-arrest)
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Cardiac (non-arrest) research
18 recent papers on cardiac (non-arrest) in paramedic and prehospital care, newest first. Each has a plain-English summary, the study design, the main finding and caveat, and what it means for Australian practice.
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Overdrive pacing for refractory pVT prehospital
A prehospital case report describes transcutaneous overdrive pacing used as rescue therapy for refractory polymorphic ventricular tachycardia after cardiac arrest, highlighting the gap between guideline options and what ambulances actually carry.
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Who doesn't call an ambulance for chest pain
Systematic review of 14 Australian studies testing whether equity-related factors affect EMS use for acute coronary syndrome — EMS use ranged 36–79%, with under-49s up to 68% lower odds of calling than over-65s, men 11% lower than women, overseas-born 15% lower, non-English speakers 6–20% lower and remote residents 25% lower than city dwellers.
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POC troponin on ambulances: fewer ED visits
A French economic model built on 737 patients found prehospital point-of-care high-sensitivity troponin reduced ED attendance (90.9% vs 96.7%) and ED length of stay (1.63 vs 2.76 hours) versus standard care for suspected acute coronary syndrome.
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Prehospital ACS risk stratification: the evidence
A narrative review of prehospital ACS risk stratification found HEART-derived pathways combined with point-of-care troponin carry the strongest evidence for safe field risk assessment, while AI-assisted ECG interpretation remains promising but prospectively unvalidated.
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Self-presenting STEMI patients fare worse
Tehran cohort of STEMI patients found those who self-presented had 2.17 times the in-hospital mortality of EMS-transferred patients, alongside longer door-to-balloon times (60 vs 49 minutes).
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Cardiogenic shock: prehospital recognition and routing
Best-practice review of cardiogenic shock systems of care covering prehospital and ED evaluation argues early identification and direct routing to shock centres prevents irreversible organ damage, while conceding prehospital identification remains difficult.
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A third of MI patients delay over two hours
A cross-sectional study of 105 myocardial infarction patients in Ahmedabad found a median symptom-to-hospital time of 90 minutes, with 35.2% delayed beyond 2 hours and female sex predicting delay (OR 3.2).
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12-lead transmission lags equipment availability
A national survey of 588 of Japan's 723 fire departments found 92.7% had at least partial 12-lead ECG recording capability but only 9.7% routinely recorded and transmitted, with chest pain/ACS protocols — not equipment — the strongest driver of transmission uptake.
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Only 60% of paramedic-suspected STEMI confirmed
A retrospective Victorian statewide ambulance registry cohort (2020–25) followed up paramedic-suspected STEMI presentations and found STEMI confirmed in only 60% of those with a recorded discharge diagnosis, with 30-day mortality of 6.5%.
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Prehospital STEMI data transmission speeds reperfusion
In 409 Chinese STEMI patients, prehospital WeChat transmission of patient data to the PCI centre shortened symptom-to-first-medical-contact (75 vs 120 minutes), door-to-balloon (50 vs 67 minutes) and total ischaemic time (121.5 vs 150 minutes).
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48-hour AF cardioversion threshold abandoned
EMA commentary arguing the once-conventional 48-hour elective cardioversion threshold for recent-onset atrial fibrillation is no longer supported
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Aortic emergencies: HR/BP drugs in transport
Cohort of 1,530 aortic emergencies in US critical care transport — esmolol, labetalol and nicardipine strategies hit HR/BP targets at similar rates, with esmolol alone showing the highest hypotension incidence (9.3%) and labetalol alone the lowest (2.1%)
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LLMs unreliable for cath-lab activation ECGs
Retrospective test of three multimodal LLMs against real cardiology cath-lab activation decisions on 615 prehospital ECGs found the best (Gemini, 95.3% sensitivity) had 9.4% specificity, and the standard ECG machine algorithm beat all three LLMs overall — general-purpose LLMs aren't reliable for STEMI pathway activation.
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Only a third get PHT within 30 min
This Australian study identifies factors affecting timely prehospital thrombolysis delivery in Victoria's pharmacoinvasive STEMI network.
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FLAG score predicts circulatory support need in shock
The FLAG risk score is a simple, registry-based model to predict MCS treatment during hospital stay in a prehospital setting.
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SCARE score validates for chest pain triage
They prospectively validated the SCARE score for predicting acute myocardial infarction during telephone triage across multiple French emergency communication centers, finding good discrimination and calibration but noting limitations in real-world implementation.
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EMS protocols rarely guide pads in STEMI
They reviewed whether EMS protocols adequately address defibrillator pad placement in prehospital STEMI care, and found significant variability and gaps that may compromise monitoring and pacing capability during transport.
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PANDA trial: noradrenaline vs adrenaline in shock
This multicenter RCT protocol tests whether noradrenaline improves outcomes compared with adrenaline for paramedic management of cardiogenic shock, with the PANDA trial aiming to settle the debate on optimal vasopressor choice in the prehospital setting.