When it comes to heart attacks, a few minutes of delay can mean the difference between recovery and life-long complications – or worse. But Canadian researchers say they've found a way to speed up care significantly.
These days, most hospitals aim to get patients who are experiencing a clot-related heart attack into surgery within 90 minutes of paramedics arriving to help. Yet a group of researchers in Ontario has figured out how to shave off an astonishing 20 minutes off that time.
The researchers presented their approach this week to colleagues at the American Heart Association meeting in Chicago, showing how they've streamlined the system in innovative ways to potentially save more lives.
One of the key changes involves having paramedics speak directly to the cardiologist on call at the hospital.
The paramedic performs an ECG test on the patient, reports the patient's status, and then calls for the activation of the hospital's angiography suite, where doctors will insert a tiny balloon in the heart to open up the vessels.
Once the patient and the paramedics arrive at hospital, they bypass completely the emergency department and instead are escorted by an operating room nurse directly to the procedure room.
"We bypass essentially anything that causes delays in the system," explains Dr. Sheldon Cheskes, the medical director of the Sunnybrook Osler Centre for Prehospital Care who led the research.
Getting patients who are having a serious heart attack called a STEMI (ST elevation myocardial infarction) into the procedure room as quickly as possible is critical. Studies have shown that for every half hour delay, the death rates go up significantly. Even for those who survive, the longer a patient waits for care, the more likely they are to incur permanent damage to their heart.
"We are taking patients who would have had larger damage to heart muscle and turning them into patients who have essentially no damage to the heart muscle," Cheskes says.
Ed Skrlj is one of those who has benefitted from the new approach.
A year ago, the 55-year-old had a heart attack. It was a Friday night and he developed chest discomfort that he first thought was heartburn. When he could feel his heart start to pound he told his wife to call 911, still not aware he was having a heart attack.
A large clot was choking off blood flow to his heart and he needed an angioplasty to unblock it. He got one in just 48 minutes from the time the paramedics arrived.
After the procedure, doctors found that Skrlj had three other dangerously narrowed heart arteries and required a triple bypass. But he says the quick response from doctors to his initial heart attack has made all the difference to his outcome.
"I have no damage to my heart at all because it was so quick," he says.
In the study presented at the AHA meeting, Cheskes and his team compared times for 95 heart patients in the Mississauga, Ont. region served by the Trillium Health Centre, before the new approach was implemented, and 80 patients after.
The proportion of patients who got their angioplasty within 90 minutes of paramedics arriving increased from 28 per cent before, to 91 per cent after. The median time from arrival at hospital door to getting the procedure decreased from 83 minutes before to 34.5 minutes after.
"From a mortality point of view, our mortality rate before we started our program was about 6.5 per cent. Our mortality currently is 2.1 per cent, which is a huge, significant increase," says Cheskes.
Paramedics involved in the new approach are also pleased, says Greg Sage, director of Halton EMS and one of the co-founders of the program.
"We are extremely pleased with the results," he says. "This is one of the most exciting things we've done in the last 15-20 years."
He says for paramedics to speak to a cardiologist in a lab is something previously unheard of.
"It's rewarding for the staff to see that they are making a difference," he says.
With a report from CTV medical specialist Avis Favaro and producer Elizabeth St. Philip
