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A Prehospital Randomised Controlled Trial in South Africa: Challenges and Lessons Learnt
Department of Clinical Research and Education, Karolinska Institutet, Sweden; Division of Emergency Medicine, Stellenbosch University, Cape Town, South Africa.
Division of Emergency Medicine, Stellenbosch University, Cape Town, South Africa.
Department of Emergency Medicine and Services, Helsinki University Hospital, Helsinki University, Helsinki, Finland.
Department of Emergency Medical Care, University of Johannesburg, Johannesburg, South Africa.
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2019 (English)In: African Journal of Emergency Medicine, ISSN 2211-419XArticle in journal (Refereed) Epub ahead of print
Abstract [en]

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.

Place, publisher, year, edition, pages
Elsevier, 2019.
Keywords [en]
ST-elevation myocardial infarction, South Africa, Telemedicine, Randomised controlled trials, Research methods
National Category
Medical and Health Sciences Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
URN: urn:nbn:se:oru:diva-71586DOI: 10.1016/j.afjem.2019.02.002OAI: oai:DiVA.org:oru-71586DiVA, id: diva2:1280181
Available from: 2019-01-18 Created: 2019-01-18 Last updated: 2019-04-24Bibliographically approved

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CiteExportLink to record
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