A Prehospital Randomised Controlled Trial in South Africa: Challenges and Lessons Learnt

Stassen, WillemDepartment of Clinical Research and Education, Karolinska Institutet, Sweden; Division of Emergency Medicine, Stellenbosch University, Cape Town, South Africa (författare)

A Prehospital Randomised Controlled Trial in South Africa : Challenges and Lessons Learnt

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 randomisation, 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 care.

Wallis, LeeDepartment of Emergency Medicine and Services, Helsinki University Hospital, Helsinki University, Helsinki, Finland (författare)
Castren, MaaretDivision of Emergency Medicine, Stellenbosch University, Cape Town, South Africa (författare)
Vincent-Lambert, CraigDepartment of Emergency Medical Care, University of Johannesburg, Johannesburg, South Africa (författare)
Kurland, Lisa,1960-Örebro universitet,Institutionen för medicinska vetenskaper(Swepub:oru)lkd (författare)
Department of Clinical Research and Education, Karolinska Institutet, Sweden; Division of Emergency Medicine, Stellenbosch University, Cape Town, South AfricaDepartment of Emergency Medicine and Services, Helsinki University Hospital, Helsinki University, Helsinki, Finland (creator_code:org_t)

Ingår i:African Journal of Emergency Medicine: Elsevier9:3, s. 145-1492211-419X
Ingår i:African journal of emergency medicine : Revue africaine de la medecine d'urgence: Elsevier9:3, s. 145-1492211-4203

Av författaren/redakt...: Stassen, Willem; Wallis, Lee; Castren, Maaret; Vincent-Lambert, ...; Kurland, Lisa, 1 ...

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