PITTSBURGH (KDKA) — Emergency care for heart attacks is getting a new focus.
It has been thought the most critical time for surviving a heart attack is door-to-balloon time: the time from the ambulance arriving at the emergency department to the time you get to the cath lab to open up a blocked heart vessel.
Many hospitals have it down to under an hour, which is below the American Heart Association recommendation of 90 minutes.
“Once a patient showed up in the emergency department, we could work with our colleagues in cardiology to shorten that time. It was the easiest one to focus on. That’s why we started there,” says West Penn Hospital ER physician Dr. Bruce MacLeod.
A study in the New England Journal of Medicine is challenging that concept.
Researchers found that as door-to-balloon times grew shorter, there was not an associated change in the number of deaths.
“What it says is that the focus in the hospital was necessary, but insufficient,” says Dr. MacLeod.
So the focus is now shifting to shortening the time between the onset of symptoms and treatment with special attention to that first medical contact with first responders – within minutes getting a 12-lead EKG, a heart rhythm test, and immediate communication with the cath lab at the hospital.
“We can get them there quick and get them there, but it’s really notifying them early, getting the treatment started early, and making sure we get to an appropriate hospital,” says Talo Capuzzi of Ross/West View EMS.
“We’re trying to make sure across western Pennsylvania everybody can get a 12-lead and transmit it. If you get that within five minutes of arrival, you send that, the cardiac cath team starts coming in while they’re bringing the patient to the hospital. You meet at the same time, you’re overlapping your processes, and that reduces the time significantly,” explains Dr. MacLeod.
Capuzzi was recently on a call where this occurred.
“We told him, it’s a life-threatening emergency. We transferred him straight from our stretcher to the cath lab table. He did extremely well, he was discharged not long afterward with no lasting effects,” he describes.