Thursday, March 29, 2007
Most heart attacks are caused by a blocked artery. The faster a patient can get to a hospital and get the artery opened, the less heart muscle will be damaged. A new high-tech program begun at Esconido's Palomoar Hospital is designed to speed the treatment of heart attack victims. KPBS Health Reporter Kenny Goldberg has the story.
It's 11:20 a.m. in Palomar Hospital's ER. In the radio room, nurse Karen Cumming gets a call from paramedics about a possible heart attack victim. Paramedics give the person an EKG test. Rather than interpreting the test themselves, and they send the results through the cell phone to the hospital.
Paramedics ask Cumming whether she wants to declare a cardiac alert.
Cumming: We're going to run that EKG past our base hospital physician, if you stand by one moment.
Another nurse runs a copy of the EKG to an ER physician. The doctor confirms the patient is having a heart attack. Cumming hails the ambulance again.
Cumming and Paramedic: 1492 this is Palomar….1492 go ahead…we'll be running this as a cardiac alert and the cardiologist has been notified.
Cardiologist Dennis Leahy gets a page. By the time he gets to the ER at 11:30, the patient has already been wheeled in. That's just ten minutes after paramedics alerted the hospital.
Leahy: Can we start aspirin? I just gave one nitro under the tongue, aspirin's ready to go next. OK, aspirin, and weight-adjusted heparin for lidic therapy. Yeah, any bleeding issues or anything?
Dr. Leahy looks at the patient's EKG. He nods his head, and turns to the patient.
Leahy: It looks like the artery's blocked off. So we're going to get you started on some medicines here and get you upstairs to the cath lab, and do an angiogram and try to open the artery up, okay?
At noon, the patient is up in the cath lab, and things get underway. Cardiovascular specialist Mary Morales monitors the procedure from the control room. She describes what Dr. Leahy is doing.
Morales: He's advancing a wire that's point-zero-one-fourth of an inch, through the coronary artery, trying to get through the blockage, so that he can advance an angioplasty balloon through it, through the wire, but getting through that clot is sometimes difficult.
Finally at 12:45, Dr. Leahy pushes through the clot, inflates the balloon, and gets blood flowing through the blocked artery. It's been 75 minutes since the patient was brought to the hospital. Cardiologists say the ideal door-to-balloon time is 90 minutes. Palomar's average is 80.
Dr. Leahy says Palomar's cardiac alert program is designed to get quick treatment to heart attack patients.
Leahy: We know morbidity and mortality are highly dependent on how quickly the artery gets reopened after it closes off. So the idea of getting pre-hospital identification of the patients, having it wirelessly, the information, get to us, and we know we can get them to the cath lab urgently, that has had a huge impact on treatment.
Leahy says if a patient gets to the hospital and the artery is opened within 90 minutes, the 30-day hospital mortality rate is about three percent. If the patient's treatment is delayed by another hour, the mortality rate nearly doubles.
In 2003, Palomar became the first hospital in California to get wireless EKGs from the field, and have emergency angioplasties available at all times. Since then, Palomar has screened nearly 2900 potential heart attack patients. 200 have gone to the cath lab.
This January, 11 hospitals in San Diego County joined the effort to speed up emergency cardiac care. Dr. Bruce Haynes is the County's director of emergency medical services. He says only three local hospitals can receive wireless EKGs. The others have to rely on the machines' interpretation.
Haynes: The way the technology is, the EKG machines in the field tend to over call heart attacks. And so ten to 15 percent of the time, they say there's a heart attack there when there really isn't. A lot of these people have heart disease anyway. But, they don't need the real rapid response.
Still, Haynes says the effort will help reduce door to balloon times Countywide for people who are having a heart attack. Heart disease is the nation's leading cause of death. Haynes predicts the County's new program could reduce the heart attack death rate by up to 20 percent.
Kenny Goldberg, KPBS News.