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North Mississippi Medical Center staff has been working intently for several years to reduce treatment time for heart attack victims, and our hard work is paying big dividends for patients.
The time between a patient’s arrival at the hospital and reperfusion (restored blood flow) is called the door-to-balloon time. Guidelines from the American College of Cardiology recommend a door-to-balloon time of 90 minutes or less for patients experiencing ST-segment elevation myocardial infarction (STEMI), or heart attack caused by a completely blocked artery.
In STEMI cases, cardiologists perform emergency angioplasty, where a thin wire with a tiny balloon on the end is threaded through an artery to the blockage. When the balloon is inflated, it clears the blockage and restores blood flow to the heart. Many times a wire mesh tube, called a stent, is also placed to help prop the artery open and prevent re-blockage. The longer the artery is blocked, the more damage is done and the greater the risk for complications. The faster blood flow is restored, the better the patient will fare.
Now when a patient comes to the ER with chest pain, the staff has a “standing order” to do an EKG, which means they can rush to do it without waiting for a physician’s order. While the EKG is being done, staff is taking vital signs, drawing blood, administering oxygen and giving aspirin if indicated. All of this is being done before the ER physician even enters the room.
If the EKG shows a heart attack, the ER physician simultaneously notifies the cardiologist and the Cardiac Catheterization Lab, and everyone scrambles into action. Certain clot-preventing drugs are given automatically. The cardiologist gets the patient’s history and does an exam while the Cath Lab staff prepares to do the procedure.
Because the cardiologist and Cath Lab staff are activated immediately, no time is lost between the ER and the actual procedure. If an NMMC ambulance or CareFlight, NMMC’s medical helicopter, respond to the patient, the paramedics do an EKG on site and notify the ER physician of results. Under the new protocol, patients who have been transferred to NMMC from another hospital’s ER, are taken directly to the Cath Lab.
In 2007, slightly more than half of heart attack patients experienced a door-to-balloon time of 90 minutes or less. In recent years that number has risen to almost 100 percent of patients.
NMMC is a founding member of the Mississippi Healthcare alliance, a network of hospitals and cardiologists throughout Mississippi designed to improve treatment for heart attack victims statewide. This group’s purpose is to set a standard form of therapy that all heart attack patients should receive, and to improve access to heart catheterization labs around the state. The goal is to save lives and improve outcomes.