By avoiding delays in the ER, interventional cardiologists quickly restore blood flow to the heart
(BETHESDA, MD)-- A Michigan hospital has cut in half the time it takes to begin life-saving treatment of heart attack patients by using cell phones to transmit electrocardiograms (ECGs) from the field, according to a study in the just-published November 2005 issue of Catheterization and Cardiovascular Interventions: Journal of the Society for Cardiovascular Angiography and Interventions.
An emergency room physician reviews the ECG and, if the patient is having a heart attack, calls in the cardiac catheterization team even before the ambulance arrives at the hospital. The result: The patient is immediately whisked to the cardiovascular cath lab, where an interventional cardiologist opens the blocked coronary artery, restoring blood flow to the heart.
"Time is muscle. The more quickly we can get the artery open, the less heart muscle will be damaged," said Dr. Shukri David, chief of cardiology at Providence Hospital in Southfield, Mich. "We're mobilizing the cath lab team while the patient is still at home."
Traditionally, paramedics perform an ECG in the field if they suspect a patient is having a heart attack but do not transmit the tracing to the emergency room. Instead, patients are triaged and evaluated in the ER, and only then is the cath lab team called in to the hospital.
By basing treatment decisions on the ECG performed by paramedics in the field, physicians at Providence Hospital have been able to cut to 44 minutes the average time from patient arrival at the hospital to inflation of the angioplasty balloon that opens the blocked artery (so-called door-to-balloon time). In the past, it took an average of 88 minutes to restore blood flow to the heart.
The early triage system is not costly to set up, Dr. David said. In addition to conventional cell phones, it requires that ambulances be equipped with monitoring equipment capable of generating a standard 12-lead ECG and that the emergency room be equipped with a computer station to receive ECG data, convert it to a digital tracing, and generate a hard-copy print-out.
In addition, to ensure a rapid response, Providence Hospital requires that cath lab staff either live within 30 minutes of the hospital or remain at the hospital when on-call.
"When a patient is having a heart attack, the cath lab team needs to be there right away," Dr. David said.
Source: Eurekalert & othersLast reviewed: By John M. Grohol, Psy.D. on 21 Feb 2009
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