El Paso is 1 of 8 Sites to Test Heart Attack Remedy - @ JEMS.com

El Paso is 1 of 8 Sites to Test Heart Attack Remedy


Doug Pullen | | Monday, January 12, 2009

EL PASO, Texas -- Imagine feeling pressure in your chest, pain in your arms and shortness of breath. Could be a heart attack.

911 is called, and the paramedics arrive and give you a solution that could be the solution to your problem -- possibly slowing, even reversing a heart attack and reducing damage to your ticker.

It's not just a pump dream for a group of El Paso researchers and paramedics who hope to help make it a reality within three years.

El Paso is one of eight cities chosen by the National Institutes of Health to participate in a two-year study of the possible benefits of the treatment.

If the results are what the researchers suspect, we could see up to a 20 percent reduction in heart attacks, or myocardial infarctions, said Dr. Robert Woolard. He's the chairman of emergency medicine at Texas Tech University Health Sciences Center and the principal investigator for the local study.

"If needed, they could go right to the cath lab," where heart attack patients go to have catheters, Woolard said. "Few do it now, but you could bypass the emergency department and be sent directly to the hospital."

The study is called the Immediate Myocardial Metabolic Enhancement During Initial Assessment and Treatment in Emergency, or IMMEDIATE, trial.

"A high concentration solution of (glucose, insulin and potassium, or GIK) has been shown to mitigate the unfavorable effects associated with hypoxemia (oxygen deficiency) and ischemia (restricted blood flow) and may be a key to extending the time window for potential myocardial salvage from reperfusion therapy," according to an description on the trial's Web site, www.immediatetrial.com.

"The National Institutes of Health funded study's primary aim is to test the hypothesis that very early administration of GIK solution to patients with ACS will prevent or reduce the size of an acute myocardial infarction," it says.

Heart disease is the leading cause of death in the United States, according to the federal Centers for Disease Control and Prevention. The American Heart Association reports that more than 1.2 million Americans suffer new or recurrent heart attacks each year; nearly 830,000 of them, or 34 percent, don't make it.

The study, funded by the National Institute of Health's National Heart, Blood and Lung Institute, is an attempt to find out whether an intravenous solution of glucose, insulin and potassium, or GIK, in combination with other standard treatments, could put the brakes on, or at least slow a heart attack, or myocardial infarction, and reduce the risk of damage from reduced blood flow to the heart.

"The fluid slows that process," Woolard said.

The study is unique in that it is testing treatment administered before the patient gets to the hospital. It's conducted with the help of the El Paso Fire Department's Emergency Medical Services, whose 138 paramedics will participate in the project. Woolard said their "excellent service" is one of the main reasons the Sun City was chosen for the study.

Other cities participating are Albuquerque; Anchorage, Alaska; Bellingham, Wash.; Concord, Mass.; Macon, Ga.; New Haven, Conn.; and Sioux Falls, N.D.

"I think it's a really good thing for the pre-hospital environment," said Todd Haugen, quality improvement director for the EMS division at Texas Tech and paramedic coordinator for the project.

"Most clinical trials are in hospitals or clinics. Not a lot are done in the pre-hospital setting," he added.

El Paso paramedics appear enthusiastic about the experiment, which, if successful, could make the GIK solution the emergency equivalent of aspirin for treating heart attacks in their early stages.

"For the paramedics on the street, at least some of the feedback I've gotten is they're looking forward to being a part of something that may or may not change pre-hospital care in the future," Haugen said, noting that the study could have a major impact on how heart attack victims are cared for by EMS personnel.

"Usually, things like this become the standard of care, not just here in El Paso but for paramedics everywhere," Haugen said.

Six El Paso hospitals are joining Texas Tech and the Fire Department in the study, which could run for up to two years, Woolard said. They are Del Sol Medical Center, Las Palmas Medical Center, Providence Memorial Hospital, Sierra Medical Center, Sierra Medical Center East and Thomason Hospital.

"It was an opportunity for cutting-edge research right at our door with a system that delivers high-quality service," Woolard said of the study, being conducted nationally by the Tufts University medical center in Boston.

Here's how it works:

Paramedics will ask the patient if he or she would be willing to participate in the study. The patient has to meet certain criteria.If the patient agrees, either an IV bag, known as the Study Group Packet, containing the GIK fluid or a placebo, with the standard solution (use of placebos helps ensure accuracy of the study's results), will be used.Once admitted to the hospital, the patient, a family member or both will be given written information about the trial and asked to give permission in writing. The patient can opt out at any time.Both the GIK and the placebo will be given for 12 hours. Researchers will contact participants three times within a year of their participation to see whether any problems occur.

The belief is that the GIK solution, which may result in minor side effects, will be a quick, inexpensive solution, much as aspirin is for treating early-stage attacks.

"Any hospital can mix it. They already have the ingredients," Woolard said, noting that GIK has higher levels of ingredients common in the human body. "The excitement about this has been that this is something simple and inexpensive to do."

Paramedics will begin "recruiting" patients by the end of this month or early February, Woolard said. About 100 patients are expected to be enrolled locally -- and about 900 nationally -- over the duration of the study, he said.

The trial is expected to run two years, followed by federal approval or denial within a year after that, Woolard said.

It's not open to everyone -- only people who are 30 or older and are suffering symptoms, who have symptoms of acute coronary syndrome and whose electrocardiogram results show significant readings for certain symptoms.

A representative sample of 200 local households was surveyed in April, and 70 percent were found to be amenable to participating if they suffered a heart attack, Woolard said.

"Overall, the survey was very positive," he said. "People in El Paso want this to happen."

Haugen added: "I look at it from a personal standpoint if something like this happens and something like this is started by paramedics and speeds the recovering, or even stops the process with something as simple as this, it could be beneficial to my family."

Doug Pullen may be reached at dpullen@elpasotimes.com; 546-6397.

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Related Topics: Cardiac and Circulation

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