Life-saving technology sends heart attack victims' info to hospital before arrival
Saving time means saving heart function, saving money, saving lives.That's why Dennis Rowe is confident hospitals and doctors are going to welcome new technology that could help them cut the guesswork when a patient is having a heart attack, and be ready to treat a patient the second he or she arrives by ambulance.
Rowe is market general manager for Rural/Metro ambulance service, which has outfitted 30 ambulances with Physio-Control's Lifepak combination defibrillators and monitors, at $15,000 per unit. The units - which Rural/Metro has used for about a year now - let emergency medical technicians restart the heart in the event of cardiac arrest. They also have a dozen leads that, when placed on a patient's chest, can provide a detailed picture of what's going on with the heart.
But within the next month or so, Rural/Metro will also have the capability to send that detailed picture ahead to the hospital, via cellular technology, while the ambulance is en route. Emergency-room physicians can get a clear, sharp EKG reading, along with the patient's vital statistics and even notes from the paramedics, if desired. Then doctors at the hospital can securely send that information on to a cardiologist on call, or a cardiac catheterization lab at that or another hospital. By the time the patient arrives at the hospital, an on-call cardiologist may be on site or at least on the way; the cath lab may be prepped and ready for the angioplasty or stent procedures that could open up a heart attack patient's blood vessels, minimizing damage.
"That doctor can make a very good decision with that information, and activate that very elaborate and expensive system to get the best care for the patient" quickly, Rowe said. "If we get the right information into the hospital, and they make the right decision with it, that can change everything" for some patients.
Theoretically, it would make the most difference to patients who are having ST-elevation myocardial infarctions, or STEMIs, a type of heart attack that occurs when a coronary artery is suddenly completely blocked. STEMIs have substantial risk of death and disability.
About 400,000 of the 865,000-odd heart attacks that occur each year in this country are STEMIs, and there are two standards for unblocking the artery to treat them: "clot-busting" drugs, or angioplasty, in which a tiny wire is inserted into the blocked area of the artery and a balloon inflated to reopen the artery and restore blood flow to the heart.
But the recommended time frame for either procedure is limited: within 30 minutes of the heart attack for the drugs, 90 minutes for angioplasty. Studies suggest that fewer than half of STEMI patients are treated within that time frame after they arrive at the hospital. About 30 percent don't get the treatments at all, in part because only about a quarter of the nation's hospitals are equipped to perform angioplasty. (Knoxville's hospitals are.)
That's where EMS technicians and Lifepak monitors come in. In the American Heart Association's ideal "Mission: Lifeline" plan, EMS staff would be trained to use the 12-lead monitors to find out whether a patient is having a STEMI, and then send that information on to the hospital from the field.
Rowe said Rural/Metro's EMS technicians have been trained to use the 12-lead Lifepak monitors, which are going to be equipped with transmitters, thanks to financial support from Knox County Commission with help from Knox County Health Department. The county paid a total $40,000 or so for transmitters for all the monitors, Rowe said.
Then it's up to the hospitals to be able to receive the information. In Knoxville, Covenant is taking a lead role, investing $20,000 each for receiving systems for Parkwest and Fort Sanders Regional medical centers.
Rowe said he and Covenant director of cardiovascular services Darrell Brackett, who had worked together previously when both had other jobs, had been talking for a couple of years about the possibility that EMS could have given hospitals advance notice of incoming STEMI patients. When Physio-Control's Lifepak-compatible technology - called "Lifenet" - caught up, Rowe said, Brackett was already on board.
"Time is heart muscle, and every second that ticks off the clock diminishes the patient's chance of "survival or quality of life, Brackett said. But most hospitals can't keep a cardiologist on site 24 hours a day, nor is it feasible to make the cath lab ready without being reasonably sure that a patient has STEMI. So patients traditionally weren't diagnosed until arriving at the hospital, after which the chain of events for angioplasty were set in motion. How much time that takes depends on the hospital; in some parts of the country, average is two hours or more.
Brackett said that right now, Parkwest can get a STEMI patient in for treatment within about 25 minutes of arrival. But he envisions being able to shave as much as 18 or 20 minutes off that time once the Lifenet system is in use, meaning a patient could get artery-opening treatment in a matter of minutes.
"That may significantly contribute to better patient outcomes," Brackett said, and lead to quicker recovery time and shorter hospital stays.
In fact, in a study published a year ago in Circulation: Journal of the American Heart Association, when a Dallas hospital implemented changes to lessen the time between a patient's arrival at the hospital and getting the angioplasty procedure, patients had less heart damage, shorter hospital stays and reduced cost of care.
As "door-to-balloon" time decreased by a third - to 75 minutes - the size of the heart attack suffered by patients decreased 40 percent, the study found. The average length of stay fell from five days to three, and costs per admission decreased by nearly $10,000 per patient, from $26,826 to $18,280.
Though Covenant hospitals are the first in Knox County to purchase the receiving system, Rowe said Mercy Health Partners - which includes Baptist and St. Mary's hospitals - have said they intend to get the receiving system, and Rural/Metro has an upcoming meeting with University of Tennessee Medical Center. (UTMC actually had a grant to use a similar system, a predecessor to Lifenet, several years ago; the analog information arrived in a form similar to a fax.)
"Anybody who's a major heart center - and that's every (Knoxville hospital) - is going to want the information," Rowe said. "No. 1, it's the right thing to do for your patients. No. 2, given what other devices cost in health care, this is not too bad" cost wise.
With just fewer than 14,900 deaths from cardiac events yearly - including more than 800 of them in Knox County - Tennessee ranks in the top five states with the highest heart attack mortality. Could Lifenet change that?
Rowe does expect other counties to soon follow Knox County's STEMI lead. Brackett said Covenant intends to work with other ambulance services in counties where it has hospitals.
"This could have a dramatic impact on people's lives," he said.