|Life-saving procedure minimizes damage to heart muscle.
LANGHORNE, Pa., February 17, 2009 – St. Mary Medical Center is among the most successful hospitals nationwide in performing emergency angioplasty within the optimal time frame in response to a heart attack. St. Mary is averaging well below the recommended 90-minute door-to-balloon time with a monthly average closer to 77 minutes, and in some cases closer to 50 minutes.
National guidelines developed by the American College of Cardiology (ACC) and the American Heart Association (AHA) state that hospitals treating heart attack patients with emergency angioplasty should strive for a door-to-balloon time of 90 minutes or less. Door-to-balloon time refers to the time frame from a patient’s arrival at the hospital to the physician’s inflation of the angioplasty balloon within the blocked artery. This life-saving emergency procedure is performed in a cardiac catheterization lab and uses state-of-the-art technology to locate and open blocked vessels to restore blood flow to the heart. By quickly locating and treating the site of the blockage, emergency angioplasty reduces the damage to heart muscle and helps to preserve heart function in the future. When the artery is closed, the heart muscle is dying.
At St. Mary, the quality commitment to performing emergency angioplasties begins with a rapid diagnosis in the emergency room, as well as the appropriate protocols and staffing in place to perform angioplasty around the clock – 24/7 – on heart attack patients.
“Time is the most important element when you’re treating a heart attack patient. We must work collectively and very collaboratively to get the procedure moving,” says Dr. Gary Zimmer, Chair of Emergency Medicine. The rapid-response team typically involves a board-certified emergency physician, emergency tech, and two nurses who use a 12-lead EKG to quickly diagnose the location and severity of the heart attack and then also establish intravenous access for effective medication. The physician also calls the stat line that activates the cath lab team. Not only does the emergency team work closely with the cath lab team, but close coordination also is required with the pathology lab for urgent test results and the pharmacy for priority medications. “It is a level of performance in which every second impacts a patient’s chance for survival and meaningful recovery,” Zimmer adds.
“Our emergency physicians play a major role in taking ownership and having the authority to activate the response team,” says Dr. Ronald Fields, Medical Director of the St. Mary Catheterization Laboratories. “Patients are in awe at how fast everything happens – from communication in the ambulance, to quick lab results and drug orders from pharmacy, and even the quick patient transfer to the cath lab which is ready and waiting. Time is muscle, and we have worked to shorten every phase in this process.”
Angioplasty is performed in the cath lab by a special team of board-certified interventional cardiologists and specially trained nurses and technicians. The cardiologist inserts a thin tube into the main blood vessels near the heart and uses it to inflate a tiny balloon to widen an artery blocked or narrowed from the buildup of cholesterol-laden plaque. A cylinder stent often is placed to keep the blood vessel open.
“On average, our door-to-balloon time is 77 minutes or below, and just as importantly, 95 percent of our patients are treated in less than that 90-minute measure, including on nights, weekends and holidays – a feat that not every hospital can accomplish,” says Fields. He adds that although most acute heart attacks can be treated successfully by angioplasty with no need for open-heart surgery, St. Mary also has exceptional surgical capability in the event that a patient needs open-heart surgery. “Patients and physicians alike need the added confidence that interventional cardiovascular procedures are performed at hospitals with a comprehensive cardiovascular surgery program. This is not the case at every hospital.”
Life-saving angioplasty is safer when physicians and hospital staff have more experience with the procedure. Nearly 4,000 patients are treated annually in the St. Mary Cath Labs, making the labs among the busiest in the region. To date, nearly 40,000 catheterization procedures have been performed by St. Mary physicians.
“Studies have consistently shown that angioplasty patients do better if treated at hospitals and by doctors that perform a large volume of these procedures each year,” says Dr. George Heyrich, Medical Director of Interventional Cardiology at St. Mary. “We’ve refined our process in moving patients through the lab. The time when a patient arrives in the lab to the time when the balloon is inserted and inflated can be as short as 15 minutes. We are very well practiced in this protocol, and we do it well,” concludes Heyrich.
In summary, St. Mary has focused on process improvement, parallel processing, and interdisciplinary cooperation and coordination to substantially reduce door-to-balloon times, and thus improve patient outcomes. The clearer and more detailed images and shorter procedure times offered by the new cath labs that St. Mary opens in early 2009 will serve to further streamline procedural times for emergency angioplasties performed at St. Mary.