Deputy Superintendent Kuan-Cheng Chang

Department of Internal Medicine

Cheat death! China Medical University Hospital has developed the “acute ST-segment elevation myocardial infarction” AI smart diagnosis system to match the small, individualized EKG device and simple electrode strips (QT Medical Inc.) so it can assist front-line medical staff to judge if it’s an acute myocardial infarction episode and shorten the diagnosis time as patients arrive at the hospital. CMUH has also started collaborating with the Taichung City Government and Nantou County Government to introduce the ”Central Taiwan heart rescue AI network” this year (2021) to safeguard the health of citizens in Central Taiwan.

Acute Myocardial infarction (AMI) leads to an extremely high risk of patient mortality. If an acute ST-segment elevation myocardial infarction (STEMI) case is not discovered at the time the symptoms present themselves and the symptom-to-door time is delayed without adequate management, including the emergent treatment of cardiac catheterization, it may cause an even higher mortality risk and worse prognosis. Many medical centers can implement a D2B (door to balloon) time of 60 to 90 minutes (this is the time of the patients’ cardiac circulation from their arrival to the implementation of the cardiac catheterization). However, when it comes to real-time diagnosis before the patient's arrival, this isn't done domestically or internationally. The CMUH team has combined the efforts of clinical physicians and research engineers to develop the ”acute ST-segment elevation myocardial infarction“ system – an AI smart diagnosis system to match the small, individualized EKG device and simple electrode strips (QT Medical Inc.) to establish a fast, remote automatic diagnosis of patients before their arrival at the hospital to effectively shorten the S2B (symptom to balloon) time and allowing for a greater chance of recovery of cardiac circulation after their arrival.  

Deputy Superintendent Kuan-Cheng Chang, Department of Internal Medicine, CMUH, indicated that in order to put the system into practice at venues beyond hospitals, CMUH has collaborated with both fire bureaus of Taichung City Government and Nantou County Government to launch the ”Central Taiwan heart rescue AI network” program, by way of simplified EKG electrode strips to replace the traditional 12-lead electrodes for the convenience of front-line rescue teams. The device instantaneously uploads the results indicating “it’s STEMI or not” to the app on the tablets or smart phones in the ambulance right away. The "Central Taiwan cardiac rescue AI network” system was launched in July this year (2021) and was implemented on the first acute ST-segment elevation myocardial infarction patient at around 8 o’clock a.m. on July 27^th. The patient contacted the ambulance with an emergency after they started having chest pains that morning. The staff of the Zhushan Division of the Fire Bureau of Nantou County immediately conducted EKG checks (08:24:53). The result was sent back for the on-site reading around one minute right after the AI assistant system reading was completed (08:26:00), as shown as Figure 1. The patient was later transferred to the hospital and the required emergent cardiac catheterization was completed to unblock the totally obstructed right coronary artery through real-time management with the physician and the online assistance function (Figure 2). The second case of a confirmed acute ST-segment elevation myocardial infarction before arrival was completed by staff of the Renhua Division of the Fire Bureau of Taichung City on October 21^st. The time it took for the EKG to record by front-line rescue staff (13:38:04) to the time the result was sent back for the on-site reading (13:38:36) was only around 30 seconds with the AI assistant system. Meanwhile, it was reported through the Taichung City e-reporting system on the tablet to inform the transferred hospital to prepare for an emergency at the ER as well as the required cardiac catheterization.

The “Central Taiwan cardiac rescue AI network” is currently working for services in both Taichung City and Nantou County to assist more patients suffering from acute myocardial infarction with an earlier diagnosis so they can receive the required treatment in time and avoid unnecessary loss of life or severe complications due to a delayed diagnosis. During the critical time of the Covid-19 pandemic, remote medical services will become mainstream and such an AI assisted system will not only help to shorten the diagnosis time of myocardial infarction patients pre-arrival, but can also be developed as a useful self-monitoring weapon at home for cardiac disease patients and the general public!