Electrocardiogram Sonification Accelerates Detection of ST Elevation Myocardial Infarction Compared to Analysis Based Solely on Visual Display: A Randomized Controlled Simulation Study with Medical Students

Purpose: A 12 lead electrocardiogram is the standard diagnostic method for the detection of an acute coronary syndrome, as it is also used in emergency medical services. A novel sonification method can convert an important part of the electrocardiogram biosignal into an acoustic signal: The ST segment sonification is particularly useful for the detection of transient ST elevations in patients with suspicion of acute coronary syndrome. A quick and accurate detection of transient electrocardiogram changes of the ST segment is prerequisite for proper treatment, thus having immediate therapeutic consequences. Methods: As part of an emergency training program, a cohort of n = 44 medical students was recruited to participate in a two-part study. The recently reported diagnostic accuracy with regard to audibly presented electrocardiogram sequences of different ST elevation myocardial infarction severity levels provides the background for the randomized controlled trial reported here. A part (n = 32) of the entire cohort was randomly assigned in two-person teams to either an intervention (n = 8 teams of two) or a control (n = 8 teams of two) arm, respectively, whereby all teams went through an emergency simulation where they had to detect an emerging ST elevation myocardial infarction. The intervention group was endowed with a sonification-assisted equipment whereas the control group used standard visual-based electrocardiogram diagnosis only. Results: An adjusted multivariable regression yielded a statistically significant reduction for the intervention group of the delay time from starting a first electrocardiogram to the correct diagnosis by 163 seconds (p = 0.002) corresponding to 56% of the average delay time in the control group. A subgroup analysis within the intervention arm revealed a notable impact of the attitude toward sonification on delay time between the second electrocardiogram and diagnosis. Specifically, increasing disagreement with statement “I conceived the sound of the sonification as pleasant” counterintuitively reduced the delay, whereas an increasing disagreement with “sonification was helpful in making the diagnosis” increased the delay. Conclusion: Sonification of electrocardiograms should be seriously considered as an accompanying diagnostic measure in emergency medical services in cases of suspected acute coronary syndrome. The established dependence on individual attitudes towards sonification serves to further optimize sonification aesthetics and implementation.