A More Direct Route To Critical Care For Heart Attack Patients

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Dr. Fayez Shamoon, Director of Cardiovascular Services (left), confers with Dr. John D’Angelo, Chairman of the Department of Emergency Medicine, about the life-saving potential of field assessments of patients suffering heart attacks caused by blocked arteries, known as STEMI.

Dr. Fayez Shamoon, Director of Cardiovascular Services (left), confers with Dr. John D’Angelo, Chairman of the Department of Emergency Medicine, about the life-saving potential of field assessments of patients suffering heart attacks caused by blocked arteries, known as STEMI. (Photo courtesy of Trinitas)

ELIZABETH — When the recommended timeframe of emergency angioplasty treatment for a heart attack is only 90 minutes, every minute is crucial.

When a healthcare facility is able to cut 15 to 20 minutes off its “door-to-balloon” time, the potential for saving lives soars.

At Trinitas Regional Medical Center, that life-saving potential is realized every time a heart attack patient is en route. Field assessments of emergency responders trigger an early call to the Cardiac Catheterization Lab. The Cath Lab team calls the Emergency Department where doctors can assess the patient and confirm the diagnosis immediately upon arrival resulting in reduced time spent in the Emergency Room.

Trinitas is one of the only medical centers in New Jersey to offer this direct line to cardiac care. Patients experiencing STEMI (ST segment elevation myocardial infarction, a heart attack brought on by a blocked coronary artery) have traditionally been forced to make a first stop in a hospital’s ER before being brought to a cardiac unit for treatment – a practice the American Heart Association is lobbying to change,” says Trinitas Mobile ICU Coordinator Ken Reardon.

“It comes down to doing what’s in the patient’s best interest,” Reardon says. “Now when we have a patient in the field showing STEMI, EMS responders have a 20-minute head start in notifying the hospital and the cath lab. They can perform a 12-lead ECG and transmit those results [from the truck] to the hospital and on-call staff via e-mail and fax, and they can keep that patient on a stretcher all the way to the lab.”

Reardon, along with Chairman of the Department of Emergency Medicine John D’Angelo, DO, FAAEM, Fayez Shamoon, MD, Medical Director of Cardiovascular Services, and RNs Denise Loneker and Janice Lynch were among the key players in helping transform Trinitas’ response to STEMI emergencies. For D’Angelo, who’d seen the system succeed at the Florida facility where he worked before joining Trinitas, the premise is simple. “Time is muscle,” he says. “Symptom onset [when a patient experiences chest pain] to opening the blocked artery is critical. Our patients need to recognize signs of a heart attack and present to the Emergency Department immediately. Every second counts—every second we save means we’re saving heart muscle and potentially preventing complications like fluid retention and shortness of breath.”

D’Angelo continues, “Our approach is to view medicine through the eyes of our patients. The team at Trinitas recognizes that the quicker we get blood flowing again to a patient’s heart muscle, the better the outcome. A patient’s quality of life depends on our ability to respond with a best-practice approach.” For patients arriving in an ambulance, that means being able to remain on the paramedic stretcher all the way to the cardiac lab without spending extra time at an ER stop and transferring to another stretcher. Patients who walk into the ER and present cardiac arrest symptoms are given an EKG and evaluated on the spot.

With so many departments either directly or indirectly involved in emergency cardiac patient care, effective collaboration is vital in ensuring the initiative runs efficiently. To that end, D’Angelo holds monthly meetings to assess recent cases and identify ways that “door-to-balloon” time can be even further reduced.

“We have monthly ‘door-to-balloon’ meetings of all critical personnel to scrutinize where we can pick up more time in the process,” he says. “The idea is to create a feedback loop so that everyone’s sharing information and best practices, to make sure everyone is educated on the best way to do this.”

As Reardon points out, it wasn’t difficult to bring the staff together in making the new system work. “There’s no downside to it,” he says. “It’s what’s right for the patient, which makes it what’s right for the hospital, and it’s a win for everyone.”

“This is a total collaborative effort,” D’Angelo adds. The team consists of EMS, Emergency Department Personnel — secretaries, nurses, technicians, doctors and the leadership team—catheterization lab members, the interventional cardiologist and the intensive care team who receive the patient post-procedure. Our senior administrators, Trinitas’ President and Chief Executive Officer Gary Horan and Chief Nursing Executive Bernadette Countryman are committed to making Trinitas a leader in cardiovascular care.”

That Trinitas is served by a relatively small, concentrated paramedic unit ensured that training on the new procedure could run quickly and efficiently; since September, STEMI patients from Elizabeth and the surrounding area have seen the benefits. About three patients per month are expected to be transported to the cardiac lab under this new procedure, and that can translate into dozens of lives saved every year by shaving precious minutes off the front end of a response time.

“Reperfusion is the most important part of this process,” Reardon says. “The quicker you get patients on the table [in the lab], the more heart you can save. By saving more heart muscle, you’re decreasing recovery time and patients can spend less time in the hospital.”

In conjunction with the American Heart Association’s Mission: Lifeline initiative to change the way STEMI patients are transported, received and treated,Trinitas Regional Medical Center is leading the way in providing more efficient, effective care when these types of coronary blockages threaten lives. The AHA estimates that less than half of STEMI patients around the country receive treatment within their recommended timeframes; Trinitas is taking the lead among New Jersey hospitals in changing that life-or-death trend.

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