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Paramedics pilot new device for heart patients

News-7-5-HP

Newburgh A Hudson Valley paramedic service has been authorized to test out a new treatment devise that could save heart patients' lives, stunt hospital stays and slash medical bills.

As of July 1, Mobile Life Support Services is carrying a new system called Continuous Positive Airway Pressure or CPAP (pronounced "see-pap") on board every ambulance in Orange. Ulster, Dutchess and Rockland counties.

The six-month pilot program, authorized by the Hudson Valley Regional Emergency Medical Services Council, is designed for patients suffering from early signs of congestive heart failure and a condition known as pulmonary edema, caused by an accumulation of fluid in the lungs.

The CPAP design is simple and cheap: a mask, a strap to hold it over the patient's nose and mouth and tubes connecting to a small air tank. Each one-time-use set costs about $60. It works by continuously blowing oxygen or room air, under low pressure, into a patient's airway. As the patient inhales and exhales, the CPAP's constant air current keeps the lungs partially inflated and helps clear out unwanted fluid and pressure.

Mobile Life used it for the first time Monday morning to help a 64-year-old Newburgh man suffering shortness of breath. When paramedics arrived, he was collapsed in the hallway of his apartment, gasping for air.

The lower left ventricle of his heart had gone sluggish, causing a backup of blood and fluid to leak into the air sacs in his lungs.

"The air sacs filled just like a water bottle," said Mobile Life Vice President Ed Horton. "The patient was literally breathing through water."

In this type of situation, medics roll through a series of treatments. First, they supply oxygen to the patient, then administer a combination of drugs to decrease the heart's workload.

Despite those efforts, the oxygen in the bloodstream of Mobile Life's patient was at half the normal level. He was conscious, Horton said, but could only spit out a word or two at a time.

The next step, in this scenario, is typically intubation inserting a tube down the patient's throat so he can be hooked up to a ventilator. It's an invasive and potentially dangerous maneuver, and once a patient is on a ventilator, it can take several days in the hospital to get him safely off the machines.

Use of the CPAP often eliminates the need for intubation and accompanying prolonged hospital stay.

As the Mobile Life medics loaded their patient into the ambulance, en route to St. Luke's Cornwall Hospital in Newburgh, they tried the CPAP for the first time, coaching the man to inhale and exhale as the specially designed nasal mask pushed a steady stream of air into his chest.

"The given amount of oxygen flow creates a turbulence in the flooded air sacs," said Horton. "The turbulence creates a virtual valve. After 15 or 20 minutes (with the CPAP) you'll actually start moving that fluid back into the capillary bed."

It worked like a charm on Mobile Life's guy. By the time they arrived at the hospital, Horton said, the man was speaking in full sentences, his blood oxygen at normal levels.

"This is exactly the kind of patient we put this in place for," said Horton. He predicts hundreds of CPAP cases during the pilot project. At the end of the six-month test run, the Hudson Valley Regional Emergency Medical Services Council will evaluate Mobile Life's work and decide if ambulance services throughout the region can use the CPAP. The equipment for the study was purchased by Mobile Life, which is not receiving funding from any CPAP manufacturers.

Paramedics in Albany, Long Island and Westchester County, along with about half the country, already use the CPAP system. "Understand this is not going to substitute in every case," said Horton, but as an additional tool, "this is a no-brainer."

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