Faster Catheterization for MI Patients

Getting EKGs in the field is nothing new. Transmitting them ahead to a receiving hospital isn't even that startling anymore. Now a hospital in North Carolina has taken the next step, enabling its local paramedics to forward readings from the field all the way to its cardiologists.

Speeding the EKGs into the hands of the heart docs and avoiding delays in the ED allows medical staff to get a treatment team assembled and prepared to act by the time the patient gets to the hospital. Previously, that process began upon the patient's arrival at the ED.

"Historically, the person comes in to the ED and is evaluated by a physician, the physician decides it's an MI and pages the cardiologist, the cardiologist comes in and evaluates the patient, the catheterization team is called, and it's anywhere from 30 to 60 minutes of extra time down in the emergency room," says Paul Campbell, MD, medical director of cardiology at Concord's NorthEast Medical Center. "The key here is getting the cardiologist and the team activated early on, as the EMS folks are coming in."

The time this saves looks to be substantial. In its first use of the new system, NorthEast recorded a "door-to-dilation" time-the period from arrival at a catheterization lab to successful completion of angioplasty to relieve the blockage-of 33 minutes. Its previous average was 93; the national average is 104.

The first patient to benefit was a 41-year-old man who had chest pains following a workout at a local gym. Paramedics called to his home transmitted 12-lead EKG readings to Campbell, who determined he had a blocked artery and needed a catheter.

Campbell told the EMS crew to take the patient directly to the cath lab. By the time they got him there, the team was ready and able to begin treatment.

"The patient did great," says Campbell. "His ejection fraction is preserved, and he's working out again. He's back to full activities and feels fine."

As the first link in this chain, Cabarrus County paramedics play a pivotal role. Trained to look for telltale ST elevations, they forward only EKG readings that suggest myocardial infarctions. The readings go through an ED computer and to Compaq iPAQs wielded by cardiology staff. Patients with contraindications or complicating conditions can be held in the ED for further evaluation, but those with more straightforward MIs are fast-tracked.

"They go through the door and directly up," says Campbell. "I can do a directed history and get consent there, and in the meantime, the EMS folks have been trained to get the patient off the stretcher and onto the cath table, and to help out with shaving the patient and getting the EKG leads on them. The major timesaver, really, is getting everything done in the cath lab as opposed to the ED."

The technology and training was funded by support from the Duke Endowment and William T. Morris Foundation.

-JE