The moment a cardiac emergency arrives on scene, the Lourdes emergency treatment team at Our Lady of Lourdes Medical Center or Lourdes Medical Center of Burlington County is available to take action. Our staff will assess the situation and determine the severity of the problem.
In fact, with Lourdes pre-hospital ECG system, the specialists in Lourdes’ emergency department can often diagnose the nature of a cardiac emergency before the patient even arrives at the medical center. Thanks to web-based transmission of electrocardiogram information, Lourdes has continued to decrease the door-to-treatment time for cardiac emergencies.
In cases of cardiac arrest or myocardial infarction (heart attack), immediate medical response is absolutely essential. When treated early enough, damage to the heart can be minimized or even prevented. Physicians with special training in emergency medicine and registered nurses certified in Advanced Cardiac Life Support work with determination, speed, and skill. Together, they treat and stabilize the patient when every minute counts.
Team members have a full array of high-tech equipment at their fingertips. If a heart attack or other cardiac crisis has occurred, the Coronary Care Unit, with its sophisticated cardiac monitoring devices and Critical Care Nurses, is readily available.
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The time between the start of a heart attack and treatment for the heart attack is critical to saving lives and to preventing damage to the heart. That’s why Lourdes launched a new system to provide electrocardiogram (ECG) information from the site of an emergency medical service (EMS) call or during transport to the Lourdes ER–allowing the Lourdes emergency department to prepare all necessary treatment, ready from the moment of the patient’s arrival at the hospital, including activation of the cardiac catheterization laboratory.
In a heart attack caused by coronary artery disease, the small arteries on the outside of the heart (coronary arteries) that supply blood become blocked. Heart muscle begins to die precisely in relation to the extent, and the amount of time, it is denied blood flow. Interventionalists in the cardiac cath lab locate blockages and reopen them to restore blood flow to heart muscle, in a procedure called coronary angioplasty that often takes advantage of a balloon catheter to expand narrowed areas in the artery.
Specialists Can Confirm Status and Prepare
Every few minutes that go by with blocked coronary arteries make for a worse outcome from a heart attack (myocardial infarction) and increase the chance that the heart will stop functioning altogether. If the individual survives the heart attack, the duration of that time between the onset of the blockage and its treatment is a major determinant of whether the patient will end up with heart rhythm problems or eventual heart failure from weakened heart muscle.
In the past, an EMS team could report its interpretation of an ECG on the site where it was aiding the patient or in the ambulance, but this put the burden of ECG interpretation on the emergency medical technicians (EMTs). Lourdes’ LIFENET system overcomes this obstacle by permitting hospital emergency specialists to also interpret the ECG, so that this responsibility does not lie solely with EMTs.
With the system, the emergency department team can fully prepare to begin care, and can commence treatment as soon as the patient comes through the door of the hospital. The advance ECG information has proven especially helpful in activating the cardiac catheterization team when patients arrive during off hours.
With the LIFENET® System 5.0, Lourdes has chosen innovative technology and the most advanced functionality available, taking advantage of cellular web connectivity built into the widely regarded LIFEPAK unit manufactured by Physio-Control, Inc. This monitor/defibrillator provides a comprehensive set of data for managing emergency care.
When a portion of a patient’s ECG pattern called the ST segment is elevated, this signals a type of heart attack that very likely requires treatment by coronary angioplasty. This kind of heart attack is referred to as STEMI (ST-elevated myocardial infaction). The American Heart Association (AHA) estimates that every year, nearly 400,000 people in the U.S. experience STEMI. Research has shown that when an EMS screens for STEMI using an ECG in the field, patients get to the cath lab much faster than if they go through regular ER triage.
Activating the cath lab in advance, markedly decreases the amount of time it takes to get a coronary artery open. With one of the first LIFENET patients, for example, it took the team only 17 minutes to open the artery from arrival at Our Lady of Lourdes Medical Center. The approach makes emergency transport an even more sophisticated type of care and better form of hospital access for the patient who may be experiencing a heart attack-especially when compared to the common choice by patients of driving themselves to the hospital or having a friend take them there. With pre-hospital ECGs that can be transmitted, care in EMS becomes an even more valuable environment for the heart patient, much more like entry into the hospital itself.
Reliably Transmitting Data for a Survival and Recovery Advantage
Sudden cardiac arrest takes hundreds of thousands of lives every year in the U.S., often tragically or very unexpectedly. Treatment initiatives and guidelines from the American Hospital Association (AHA)and the American College of Cardiology (ACC) emphasize the need for developing STEMI systems of care to increase the number of patients with timely access to intervention.
Shortened time to treatment for heart attack has been shown to lead to increased survival. Research confirms that time from the onset of STEMI to treatment—akey component of which is “door-to-balloon time,” or time from arrival at the hospital to balloon angioplasty—is critical for improving survival and outcomes for STEMI patients. A five-year 2001 study found that the average door-to-balloon time of patients evaluated by EMS in the field with a 12-lead ECG was about one hour, compared with about 90 minutes for patients presenting to the emergency department without a pre-hospital ECG. Now that advantage becomes even greater with transmission of the ECG signal to ER ahead of a patient’s arrival.
Physio-Control operates the data centers that support LIFENET 5.0, providing high security and data redundancy and relieving EMS and hospital IT organizations from the burdens of hosting, management and support of the system. LIFENET reliably and securely distributes the information via the Web to hospital care teams on Internet-connected devices, including computers in the emergency department and cardiac cath lab as well as the cardiologist’s handheld device.
Team Relieves Coronary Blockage Faster
Cardiac interventionalists refer to pre-hospital ECG systems as “game changing” for the heart attack patient. The technology allows the receiving physician to feel confident in the EMT’s reported interpretation of the patient’s cardiac status. As a result, specialists can make treatment decisions while the patient is still in transport. And, EMS can transport patients to a facility capable of providing the appropriate treatment, including cardiac catheterization when needed.
The ER team takes appropriate patient-receiving steps in advance, sometimes including having members of the cath lab team await the patient’s arrival in the ER. This approach enables hospital teams to more consistently meet the AHA and ACC guideline for angioplastic treatment in 90 minutes or less (door to balloon time).
Rao A, Kardouh Y, Darda S, et al. Impact of the prehospital ECG on door-to-balloon time in ST elevation myocardial infarction.CatheterCardiovascInterv 2010; 75(2) :174-8.
Ting, H, Krumholz H, et al. Implementation and integration of prehospital ECGs into systems of care for acute coronary syndrome.Circulation 2008; 118: 1066-1079.
Afolabi B, Novaro G, et al. Use of the prehospital ECG improves door-to-balloon times in ST segment elevation myocardial infarction irrespective of time of day or day of week. Emerg Med J 2007; 24: 588-591.
McNamara R, et al. Effect of door-to-balloon time on mortality in patients with ST-segment elevation myocardial infarction. J Am Coll Card 2006; 11: 2180-2186.