No time to lose

Door-to-balloon time (D2B) makes the difference between death and survival from a heart attack.

There are two kinds of heart attacks: one in which an artery to the heart is partially blocked, and the other in which an artery is completely blocked. The second kind, of course, is more imminently life-threatening. Time becomes of the essence. If medical personnel can get a balloon-tipped tube to open the artery up quickly, the data shows, the patient stands a good chance of survival.

To speed up the process, local ambulances have recently been equipped with Lifenet systems that enable paramedics to hook up a heart-attack patient to an electrocardiogram (ECG) monitor and transmit the readings directly to the hospital through the Internet. Physicians can make decisions about the patient’s care while the ambulance is en route, so hospital staff can be ready to leap into action upon the patient’s arrival. Based on the ECG, paramedics can also get advice from doctors about interim treatment while the patient is still on the way to the hospital.

The American Heart Association estimates that close to 400,000 people a year in the U.S. experience the more serious type of heart attack, known as STEMI (ST-segment elevation myocardial infarction). Part of an ECG reading is the ST-segment, which is elevated in situations where a coronary artery is fully blocked. The ECG is a critical part of diagnosis, and paramedics are trained in its use.

Studies show that patient outcomes significantly improve and hospital stays are shorter (Journal of the American College of Cardiology, 2006) when door-to-balloon time is 90 minutes or less. Local emergency crews are just beginning to use the Lifenet system to pare down their D2B time.

The system was purchased by HealthAlliance of the Hudson Valley through a grant from the federal government’s Hospital Emergency Preparedness Program at a cost of $49,025, explained Richard Parrish, EMS coordinator at HealthAlliance. The Lifenet system includes a base receiving station in the Kingston Hospital emergency room and modems for the Ulster County’s six ambulance services, Woodstock Rescue, Shandaken Ambulance, New Paltz Rescue, Ellenville Rescue, Mobile Life Support Services, and Diaz Ambulance.

Transmission of ECG data requires cell service, which is not yet active in Shandaken. At the February 6 Shandaken town board meeting, the town’s ambulance service administrator, captain Richard W. Muellerleile, asked that residents notify the service if they own a Verizon network extender, which enables connection to cell service. Ambulance staff hopes to compile a confidential list of extender locations so they can get information from the cardiac monitor while still in the ambulance instead of waiting until they reach wireless network access closer to Kingston.

A network extender plugs into an existing high-speed Internet connection to communicate with the wireless network. The various brands listed on Amazon.com are priced between $100 and $200.

Kingston Hospital is among the quarter of hospitals in the United States equipped to treat patients with percutaneous coronary intervention (PCI), the preferred type of treatment for STEMI, according to the American Heart Association. PCI is a group of medical procedures that use a mechanical means to treat patients with partially or completely restricted blood flow through an artery of the heart.

Balloon angioplasty, for example, involves insertion of a tube into an artery in the groin. The tube is threaded to a trouble spot in the coronary artery, where a balloon attached to the tip of the tube is then inflated, compressing the blockage and widening the artery to restore blood flow to the heart muscle.

Another PCI procedure involves use of a stent, a wire mesh tube that is inserted to open an artery and prevent re-blockage.

A catheterization lab at Kingston Hospital enables staff to perform cardiac catheterization, a procedure to examine blood flow to the heart and test how well the heart is pumping.