Pennsylvania Hospitals Focus on “Door-to-Balloon” Time

First contact critical for heart attack patients


 
 

LUIS FABREGAS, Pittsburgh Tribune Review | | Friday, December 27, 2013


Hospitals across the region are turning their attention to first responders as they look to speed treatment for heart attack patients.

Emergency medical service providers play a crucial role in determining whether a patient's symptoms are severe enough to require angioplasty, a procedure to widen blocked arteries with a tiny balloon or a stent.

"If we really want to reduce time, we need to look at when the patient presents to the first medical contact, and that's the paramedic," said Dr. Bruce MacLeod, vice chairman of emergency medicine at Allegheny Health Network.

Doctors for years have measured the so-called "door-to-balloon" time, focusing on the time patients arrived in hospitals.

JEMS: The Role of EMS in STEMI Management (Wesley, MD, FACEP)

The emphasis has shifted to the time paramedics arrive on the scene, such as someone's home, and perform an electrocardiogram. The test helps doctors determine whether a coronary artery is blocked enough to require an angioplasty.

"We're taught that time is muscle," said Talo Capuzzi, a paramedic with Ross/West View EMS, who is working with doctors in Allegheny General Hospital in the North Side to address the issue. "Fixing the problem quickly leads to a better outcome."

Capuzzi and paramedic Kelly Bradley recently arrived at the Reserve municipal building to find a man with symptoms of a heart attack. They performed an electrocardiogram and advised doctors in Allegheny General that the man likely would need treatment in the cardiac catheterization laboratory.

"We were doing the test within five minutes of being on scene," Capuzzi said. "Before, there wasn't really a time limit."

Once the diagnosis was confirmed by a physician who read the tests results, the hospital activated the cath lab where doctors performed the angioplasty. The man recovered and is back to work.

Dr. Christian Martin-Gill, associate medical director of pre-hospital care for UPMC, said the hospital system has worked with emergency providers for several years to quickly determine whether a person with chest pain is having a heart attack.

UPMC places physicians at a medic command center around the clock so they can provide assistance to paramedics on the scene, he said.

For people with the most severe heart attacks "when a coronary artery is completely blocked there's clear evidence that the faster you get them to the cath lab, the better they do," Martin-Gill said.

More than 250,000 people a year have a severe heart attack, often called STEMI.

At UPMC Presbyterian, the push has led to improved timing. Patients who get there by ambulance make it to the cath lab in 81 minutes, on average, from the time they first were seen by a paramedic. That's within the 90-minute threshold recommended by the American Heart Association.

Allegheny General Hospital officials have noticed an improvement in timing since implementing a "first contact" protocol in May. Door-to-balloon time dropped to an average of 49 minutes in October from 72 minutes before the protocol.

That's a different measurement from UPMC's, whose numbers track the period beginning when the patient was seen by a paramedic, not when the patient arrived at the hospital.

Doctors emphasize it is important for patients to recognize and act on symptoms of a heart attack so they can get immediate medical attention.

"That's the hardest piece to really have an impact, because that requires education of everybody in the world," Martin-Gill said.

Luis Fabregas is a staff writer for Trib Total Media. He can be reached at 412-320-7998 or lfabregas@tribweb.com

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