A prehospital randomised controlled trial in South Africa : Challenges and lessons learnt

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Stassen , W , Wallis , L , Castren , M , Vincent-Lambert , C & Kurland , L 2019 , ' A prehospital randomised controlled trial in South Africa : Challenges and lessons learnt ' , African journal of emergency medicine , vol. 9 , no. 3 , pp. 145-149 . https://doi.org/10.1016/j.afjem.2019.02.002

Title: A prehospital randomised controlled trial in South Africa : Challenges and lessons learnt
Author: Stassen, Willem; Wallis, Lee; Castren, Maaret; Vincent-Lambert, Craig; Kurland, Lisa
Other contributor: University of Helsinki, HUS Emergency Medicine and Services




Date: 2019-09
Language: eng
Number of pages: 5
Belongs to series: African journal of emergency medicine
ISSN: 2211-419X
DOI: https://doi.org/10.1016/j.afjem.2019.02.002
URI: http://hdl.handle.net/10138/305772
Abstract: The incidence of cardiovascular disease and STEMI is on the rise in sub-Saharan Africa. Timely treatment is essential to reduce mortality. Internationally, prehospital 12 lead ECG telemetry has been proposed to reduce time to reperfusion. Its value in South Africa has not been established. The aim of this study was to determine the effect of prehospital 12 lead ECG telemetry on the PCI-times of STEMI patients in South Africa. A multicentre randomised controlled trial was attempted among adult patients with prehospital 12 lead ECG evidence of STEMI. Due to poor enrolment and small sample sizes, meaningful analyses could not be made. The challenges and lessons learnt from this attempt at Africa's first prehospital RCT are discussed. Challenges associated with conducting this RCT related to the healthcare landscape, resources, training of paramedics, rollout and rando-misation, technology, consent and research culture. High quality evidence to guide prehospital emergency care practice is lacking both in Africa and the rest of the world. This is likely due to the difficulties with performing prehospital clinical trials. Every trial will be unique to the test intervention and setting of each study, but by considering some of the challenges and lessons learnt in the attempt at this trial, future studies might experience less difficulty. This may lead to a stronger evidence-base for prehospital emergency
Subject: ST-elevation myocardial infarction
South Africa
Telemedicine
Randomised controlled trials
Research methods
ACUTE MYOCARDIAL-INFARCTION
ST-SEGMENT ELEVATION
LIFE-SUPPORT PARAMEDICS
INFORMED-CONSENT
12-LEAD ELECTROCARDIOGRAM
PRIMARY ANGIOPLASTY
EMERGENCY CARE
TO-BALLOON
TIME
REPERFUSION
3126 Surgery, anesthesiology, intensive care, radiology
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