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Code STEMI at CMMCCode STEMI at CMMC
William J. Phillips, MD, FACC
Director of Cardiology
November 10, 2011
William J. Phillips, MD, FACC
Director of Cardiology
November 10, 2011
Faculty Disclosure Information
FINANCIAL DISCLOSURE:
None
William J. Phillips, MD, FACC, FSCAI
””””
UNLABELED/UNAPPROVED USES DISCLOSURE:UNLABELED/UNAPPROVED USES DISCLOSURE:
None
POTENTIAL CONFLICTS OF INTEREST:
Employed by CMMC as an Interventional Cardiologist
CMHVI: PCI and Heart surgery close to home since May, 2003CMHVI: PCI and Heart surgery close to home since May, 2003
Heart Disease FactsHeart Disease Facts
Cardiovascular disease (CVD) #1 killer since 1900
2,500 Americans die of CVD each dayEstimated Costs: $403.1 billion dollars in 2006
Cardiovascular disease (CVD) #1 killer since 1900
2,500 Americans die of CVD each dayEstimated Costs: $403.1 billion dollars in 2006
Heart Attack is a major form of CVD1.2 million coronary attacks estimated per year
Nearly half of these people will die330,000 coronary heart disease deaths occur out-of-hospital, or in the Emergency Department each year
Heart Attack is a major form of CVD1.2 million coronary attacks estimated per year
Nearly half of these people will die330,000 coronary heart disease deaths occur out-of-hospital, or in the Emergency Department each year
Begin with the end in mind!Begin with the end in mind!
CMHVI began amidst some controversy!
Commitment to evidenced based medicine
Expectation that our earliest patients would likely be emergent or urgent cases, where
CMHVI began amidst some controversy!
Commitment to evidenced based medicine
Expectation that our earliest patients would likely be emergent or urgent cases, where likely be emergent or urgent cases, where travel to a more established center was not an option
Therefore, Primary PCI was an early emphasis. We knew we had to do a great job with our Acute MI patients!
likely be emergent or urgent cases, where travel to a more established center was not an option
Therefore, Primary PCI was an early emphasis. We knew we had to do a great job with our Acute MI patients!
What is Primary PCI?What is Primary PCI?
Primary PCI is when the initial treatment for an Acute MI is the use of balloon angioplasty and/or a stent, to open a
Primary PCI is when the initial treatment for an Acute MI is the use of balloon angioplasty and/or a stent, to open a angioplasty and/or a stent, to open a completely closed coronary artery that is responsible for the heart attack.
angioplasty and/or a stent, to open a completely closed coronary artery that is responsible for the heart attack.
Primary PCIPrimary PCI
Why do it?
How do you do it?
How do you do it faster?
How do you decide between
Why do it?
How do you do it?
How do you do it faster?
How do you decide between How do you decide between thrombolytic or primary PCI, especially at a non-PCI center?
…like most community hospitals in Maine?
How do you decide between thrombolytic or primary PCI, especially at a non-PCI center?
…like most community hospitals in Maine?
Why Do We Do PPCI?Why Do We Do PPCI?
Fibrinolytic Rx for STEMI limited by inadequate reperfusion and/or reocclusion in ~25% of pts.
An occluded infarct-related artery is
Fibrinolytic Rx for STEMI limited by inadequate reperfusion and/or reocclusion in ~25% of pts.
An occluded infarct-related artery is An occluded infarct-related artery is associated with a doubling of long-term mortality.
An occluded infarct-related artery is associated with a doubling of long-term mortality.
0 8 16 24 32 40 480
5
10
15
20
Occluded
Patent
Weeks
Mo
rtali
ty (
%)
Dalen, Gore, Braunwald et al.Am J Cardiol 1988; 62:179.
Evidence for the open
artery hypothesis:
TIMI 1
PPCI vs. ThrombolysisPPCI vs. Thrombolysis
Lower mortality
Lower reinfarction
Fewer complications
Fewer strokes
Lower mortality
Lower reinfarction
Fewer complications
Fewer strokesFewer strokes
But…. Many more variables may be at work in achieving clinical trial-like results.
And it was controversial, because it challenged community practice and referral bias.
Fewer strokes
But…. Many more variables may be at work in achieving clinical trial-like results.
And it was controversial, because it challenged community practice and referral bias.
Nallamothu/Bates: 2003…Nallamothu/Bates: 2003…
93 minutes93 minutes
NRMI 2: Primary PCI DoorNRMI 2: Primary PCI Door--toto--Balloon Time Balloon Time vs. Mortalityvs. Mortality
NRMI 2: Primary PCI DoorNRMI 2: Primary PCI Door--toto--Balloon Time Balloon Time vs. Mortalityvs. Mortality
MV
Ad
jus
ted
Od
ds
of
De
ath
MV
Ad
jus
ted
Od
ds
of
De
ath
P=0.01P=0.01 P=0.0007P=0.0007 P=0.0003P=0.0003
DoorDoor--toto--Balloon Time (minutes)Balloon Time (minutes)
MV
Ad
jus
ted
Od
ds
of
De
ath
MV
Ad
jus
ted
Od
ds
of
De
ath
P=0.01P=0.01 P=0.0007P=0.0007 P=0.0003P=0.0003
n = 2,230n = 2,230 5,7345,734 6,6166,616 4,4614,461 2,6272,627 5,4125,412
PP=0.00=0.0011
PP=0.00=0.0011
Importance of DoorImportance of Door--toto--Balloon Time: Balloon Time: 3030--Day Mortality in the GUSTODay Mortality in the GUSTO--IIb CohortIIb Cohort
Importance of DoorImportance of Door--toto--Balloon Time: Balloon Time: 3030--Day Mortality in the GUSTODay Mortality in the GUSTO--IIb CohortIIb Cohort
Mo
rta
lity
(%
)M
ort
ality
(%
)
TIME DEPENDENT OUTCOME DIFFERENCES ARE MUCH GREATER IN THE FIRST HOUR!
© © CM Gibson 2006CM Gibson 2006
Berger PB, et al. Circulation. 1999;100:14-20.Berger PB, et al. Circulation. 1999;100:14-20.
Door-to-Balloon Time (minutes)Door-to-Balloon Time (minutes)
Mo
rta
lity
(%
)M
ort
ality
(%
)
>< PTCA not performedPTCA not performed
Primary PCI: AHA/ACC Guidelines
STEMI patients presenting to a hospital with PCI
capability should be treated with primary PCI within
90 min of first medical contact as a systems goal.
III IIaIIaIIa IIbIIbIIb IIIIIIIIIIII IIaIIaIIa IIbIIbIIb IIIIIIIIIIII IIaIIaIIa IIbIIbIIb IIIIIIIIIIIaIIaIIa IIbIIbIIb IIIIIIIII
9803mo01, 13
STEMI patients presenting to a hospital without PCI
capability, and who cannotcannotcannotcannot be transferred to a PCI
center and undergo PCI within 90 min of first
medical contact, should be treated with fibrinolytic
therapy within 30 min of hospital presentation as a
systems goal, unless fibrinolytic therapy is
contraindicated.
III IIaIIaIIa IIbIIbIIb IIIIIIIIIIII IIaIIaIIa IIbIIbIIb IIIIIIIIIIII IIaIIaIIa IIbIIbIIb IIIIIIIIIIIaIIaIIa IIbIIbIIb IIIIIIIII
Trends in Prehospital Delay in Patients with AMITrends in Prehospital Delay in Patients with AMI
5967 pts with AMI from 1986 to 2005
Mean and median delays unchanged in 20 years
4.6 and 2.0 hours in 2005 (1/2 patients
5967 pts with AMI from 1986 to 2005
Mean and median delays unchanged in 20 years
4.6 and 2.0 hours in 2005 (1/2 patients 4.6 and 2.0 hours in 2005 (1/2 patients are more than 2 hours)
Longer delays in older patients with DM or prior MI (higher risk patients)
Thrombolysis may be less effective and higher risk in these patients
4.6 and 2.0 hours in 2005 (1/2 patients are more than 2 hours)
Longer delays in older patients with DM or prior MI (higher risk patients)
Thrombolysis may be less effective and higher risk in these patients
AJC, Dec. 15, 2008, p1589ff, Worcester Heart Attack Study
Treatment Delayed is Treatment DeniedTreatment Delayed is Treatment Denied
Symptom Recognition
Call to Medical System
ED Cath LabPreHospital
Delay in Initiation of Reperfusion Therapy
Increasing Loss of Myocytes
Primary Angioplasty was starting to hit the public eye.Primary Angioplasty was starting to hit the public eye.
What was optimal therapy, given the multiple issues?What was optimal therapy, given the multiple issues?given the multiple issues?given the multiple issues?
CHOICE: Selection of the Optimal Reperfusion CHOICE: Selection of the Optimal Reperfusion Options for the STEMI PatientOptions for the STEMI Patient
Full Dose Fibrinolytic Full Dose Fibrinolytic
MonotherapyMonotherapy if…if…
��Door to balloon (DDoor to balloon (D--B) B) > 90 min (?how much > 90 min (?how much greater)greater)
Full Dose Fibrinolytic Full Dose Fibrinolytic
MonotherapyMonotherapy if…if…
��Door to balloon (DDoor to balloon (D--B) B) > 90 min (?how much > 90 min (?how much greater)greater)
Primary PCI Primary PCI if…if…
�� Cardiogenic shock (age < 75)Cardiogenic shock (age < 75)
�� Bleeding riskBleeding risk
�� Diagnosis in doubt Diagnosis in doubt (pericarditis/aneurysm)(pericarditis/aneurysm)
�� Door to balloon < 90 minDoor to balloon < 90 min
Primary PCI Primary PCI if…if…
�� Cardiogenic shock (age < 75)Cardiogenic shock (age < 75)
�� Bleeding riskBleeding risk
�� Diagnosis in doubt Diagnosis in doubt (pericarditis/aneurysm)(pericarditis/aneurysm)
�� Door to balloon < 90 minDoor to balloon < 90 min��Lack of access to skilled Lack of access to skilled PCI centerPCI center
��(D(D--B) B) –– (D(D--N) > 1 hN) > 1 h
��< 3 h from symptom < 3 h from symptom onsetonset
��(TNK(TNK——62% TIMI 3 flow)62% TIMI 3 flow)
��Lack of access to skilled Lack of access to skilled PCI centerPCI center
��(D(D--B) B) –– (D(D--N) > 1 hN) > 1 h
��< 3 h from symptom < 3 h from symptom onsetonset
��(TNK(TNK——62% TIMI 3 flow)62% TIMI 3 flow)
�� Door to balloon < 90 minDoor to balloon < 90 min
�� Symptoms > 2Symptoms > 2--3 h3 h
�� Lytic failure or post lysisLytic failure or post lysis
�� Skilled PCI center available, defined Skilled PCI center available, defined by:by:
•• Operator experience > 75 cases/yrOperator experience > 75 cases/yr
•• Team experience > 36 primary Team experience > 36 primary PCI/yrPCI/yr
�� Age > 75Age > 75
�� (90+% TIMI 3 flow)(90+% TIMI 3 flow)
�� Door to balloon < 90 minDoor to balloon < 90 min
�� Symptoms > 2Symptoms > 2--3 h3 h
�� Lytic failure or post lysisLytic failure or post lysis
�� Skilled PCI center available, defined Skilled PCI center available, defined by:by:
•• Operator experience > 75 cases/yrOperator experience > 75 cases/yr
•• Team experience > 36 primary Team experience > 36 primary PCI/yrPCI/yr
�� Age > 75Age > 75
�� (90+% TIMI 3 flow)(90+% TIMI 3 flow)
Mortality in relation to therapy and delay
Mortality in relation to therapy and delay
7-day mortality
30-day mortality
1-year mortality
Prehospital thrombolysis (PHT)
Primary PCI (PCI)
Any time
Adjusted outcome by Cox regression analysis including 23 variables plus propensity score.
30-day mortality
1-year mortality
30-day mortality
1-year mortality
0,80,60,4 21,2 1,50,1 1 10in-hospital thrombolysis betterPCI or PHT better
Reperfusion started <=2 h
Reperfusion started >2 h
Adjusted outcome by Cox regression analysis including 23 variables plus propensity score.
JAMA 2006;296:1749
1-y
ea
r m
ort
ality
0.1
00
.15
0.2
0
TlysPCI
Primary PCI vs thrombolysisPrimary PCI vs thrombolysisageage--adjusted 1 year mortality in relation to delay timeadjusted 1 year mortality in relation to delay time
Thrombolysis
PCI
Time for reperfusion (h)
1-y
ea
r m
ort
ality
0 -
1
1 -
2
2 -
3
3 -
4
4 -
5
5 -
6
6 -
7
7-1
0
10-1
5
0.0
00
.05
0.1
0
Tlys 122 503 503 332 239 159 121 196 1391248 4375 3659 2199 1438 946 658 1061 703
PCI 7 61 81 50 43 37 17 41 31125 895 1126 776 567 453 282 458 332
Deaths / Patients
JAMA 2006;296:1749
Door to Balloon Time!Door to Balloon Time!
There was convincing evidence that PCI was better, if it could be done promptly
National attention began to focus on achieving the best D2B’s!
There was convincing evidence that PCI was better, if it could be done promptly
National attention began to focus on achieving the best D2B’s!achieving the best D2B’s!
Centers of excellence began to establish protocols that would speed diagnosis and care.
We felt that if we could treat trauma rapidly, we could treat STEMI as well.
achieving the best D2B’s!
Centers of excellence began to establish protocols that would speed diagnosis and care.
We felt that if we could treat trauma rapidly, we could treat STEMI as well.
Recognition of ST elevation by paramedics.
Whitbread, M. Emerg Med J 2002; 19(1):66-7.
Recognition of ST elevation by paramedics.
Whitbread, M. Emerg Med J 2002; 19(1):66-7.
Objective: To define the ability of paramedics to recognize ST-elevation using prehospital 12-lead EKG
Results:
Objective: To define the ability of paramedics to recognize ST-elevation using prehospital 12-lead EKG
Results:Results:
95% accuracy
91% specificity
97% sensitivity
No difference from ER physician results
Results:
95% accuracy
91% specificity
97% sensitivity
No difference from ER physician results
Recognition by paramedicsRecognition by paramedics
Conclusions:
Paramedics can recognize ST elevation using a 12 lead EKG.
Conclusions:
Paramedics can recognize ST elevation using a 12 lead EKG.
Radio transmission of an EKG may not be necessary to pre-alert hospital, is more expensive to implement, and in Maine, may not always be possible.
(what about cell phone photos?)
Radio transmission of an EKG may not be necessary to pre-alert hospital, is more expensive to implement, and in Maine, may not always be possible.
(what about cell phone photos?)
Policy SupportPolicy Support
AHA 2004 Guidelines
ACEP Policy Statement – June 1999
Out-of-hospital 12-lead EKG
AHA 2004 Guidelines
ACEP Policy Statement – June 1999
Out-of-hospital 12-lead EKGOut-of-hospital 12-lead EKG
National Association of EMS Physicians
Position Paper: Prehospital Triage of Chest Pain Patients
Out-of-hospital 12-lead EKG
National Association of EMS Physicians
Position Paper: Prehospital Triage of Chest Pain Patients
The PlanThe Plan
12 lead EKG Course & Repeat every 3 years
All patients with chest pain or possible
12 lead EKG Course & Repeat every 3 years
All patients with chest pain or possible All patients with chest pain or possible cardiac symptoms receive a prehospital 12-lead EKG
100% EKG review from March 1, 2004 –July 1, 2005
All patients with chest pain or possible cardiac symptoms receive a prehospital 12-lead EKG
100% EKG review from March 1, 2004 –July 1, 2005
Prehospital Activation of CMHVI Cath LabPrehospital Activation of CMHVI Cath Lab
United first service in state to activate cath lab
Started 7/05
Improved morale
United first service in state to activate cath lab
Started 7/05
Improved moraleImproved morale
Decreased door to balloon time
Other services immediately wanted to join
Improved morale
Decreased door to balloon time
Other services immediately wanted to join
Activation Inclusion CriteriaActivation Inclusion Criteria
ST elevation > 1mm in 2+ contiguous leads
Ongoing symptoms i.e. chest pain, SOB….
ST elevation > 1mm in 2+ contiguous leads
Ongoing symptoms i.e. chest pain, SOB….SOB….
Palpable lower extremity pulses
Ability to give informed consent (usually)
SOB….
Palpable lower extremity pulses
Ability to give informed consent (usually)
Service AreaService Area
Now there are approx. 17 approx. 17 ambulance services trained
Extending ActivationExtending Activation
Training
All services perform 12 lead EKG’s on potential cardiac patients
Training
All services perform 12 lead EKG’s on potential cardiac patientspotential cardiac patients
100% 12 lead EKG review
All services take a 20 EKG test and have to achieve 90% to pass
potential cardiac patients
100% 12 lead EKG review
All services take a 20 EKG test and have to achieve 90% to pass
Strategies for Reducing the Door-to-Balloon Time in Acute Myocardial InfarctionBradley, E.H., et al. NEJM 2006; 355:2308-20.
Strategies for Reducing the Door-to-Balloon Time in Acute Myocardial InfarctionBradley, E.H., et al. NEJM 2006; 355:2308-20.
Six strategies to a faster door-to-balloon time:
ER physicians activate cath lab (without waiting for cardiology confirmation) – 8.2 min
Single call to central page operator – 13.8 min
Prehospital cath lab activation (depending upon
Six strategies to a faster door-to-balloon time:
ER physicians activate cath lab (without waiting for cardiology confirmation) – 8.2 min
Single call to central page operator – 13.8 min
Prehospital cath lab activation (depending upon Prehospital cath lab activation (depending upon distance to hospital) – 15.4 min
Cath staff arrival < 30 min – 19.3 min
Having a cardiologist on site – 14.6 min
Real time data feedback to ED/Cath Lab – 8.6 min
Prehospital cath lab activation (depending upon distance to hospital) – 15.4 min
Cath staff arrival < 30 min – 19.3 min
Having a cardiologist on site – 14.6 min
Real time data feedback to ED/Cath Lab – 8.6 min
Profile CaseProfile Case
53 yo wm collapses at fire scene – 30 min by ground from CMMC-Vfib arrest
United ambulance – CPR-Defib-IV-O2
53 yo wm collapses at fire scene – 30 min by ground from CMMC-Vfib arrest
United ambulance – CPR-Defib-IV-O2United ambulance – CPR-Defib-IV-O2
12 lead EKG→Ant/Lat MI
United ambulance – CPR-Defib-IV-O2
12 lead EKG→Ant/Lat MI
Profile CaseProfile Case
Cath Lab and LifeFlight activated
3 min flight – 20 min D2B
Cath Lab and LifeFlight activated
3 min flight – 20 min D2B
Patient leaves hospital 3 days laterNeuro intact
Patient leaves hospital 3 days laterNeuro intact
Early Results Prehospital Activation
Early Results Prehospital Activation
Benchmark Times
80 min or less……………………100%
70 min or less……………………89%
60 min or less……………………78%
Benchmark Times
80 min or less……………………100%
70 min or less……………………89%
60 min or less……………………78%60 min or less……………………78%
40 min or less……………………44%
30 min or less……………………15%
60 min or less……………………78%
40 min or less……………………44%
30 min or less……………………15%
““In A HeartbeatIn A Heartbeat””
As many of you are aware, in April 2006, the Dirigo Health Agency's Maine
Quality Forum launched “In a Heartbeat”, a comprehensive initiative that creates an evidence-based treatment map for patients suspected of having a heart attack in Maine.
“In a Heartbeat” seeks to reduce death and disability that result from acute In a Heartbeat seeks to reduce death and disability that result from acute myocardial infarction (AMI) or heart attack, and involves partners from across the state, (Emergency Medical Services, medical providers, Maine Center for Disease Control and Prevention, community outreach groups, and health advocacy organizations, such as the American Heart Association), workingto ensure that Mainers who have heart attacks receive timely, quality care, regardless of where they live or work, and where they are treated.
http://www.mainequalityforum.gov/iahb_tt_invite.pdf
ER admit!
In A Heartbeat programIn A Heartbeat program
Agreed upon need for public education
Ongoing review of emergency services
Could not agree on a statewide priority for transporting STEMI patients to the
Agreed upon need for public education
Ongoing review of emergency services
Could not agree on a statewide priority for transporting STEMI patients to the for transporting STEMI patients to the closest PCI center!!! (unlike the Trauma protocol)
Data collection unfunded
Poster never produced or distributed
for transporting STEMI patients to the closest PCI center!!! (unlike the Trauma protocol)
Data collection unfunded
Poster never produced or distributed
Go in an Ambulance
• Person having a heart attack will be seen more quickly
• EMTs communicate with ER doctors
• ER can prepare for arrival• ER can prepare for arrival
• EMTs can monitor condition andbegin treatment
• Time saved is muscle saved
ACC databaseACC database“As reported in the 2007 Cath/PCI Registry Outcomes Report, the average Door to Balloon time was 118 minutes for the 767 hospitals reporting.
Central Maine Medical Center’s average time
“As reported in the 2007 Cath/PCI Registry Outcomes Report, the average Door to Balloon time was 118 minutes for the 767 hospitals reporting.
Central Maine Medical Center’s average time Central Maine Medical Center’s average time then was 60 minutes which beat the average by 58 minutes!
National D2B Goal is 90 minutes or less.
Most recent data reporting showed CMMC D2B time averaged 51 minutes!
Central Maine Medical Center’s average time then was 60 minutes which beat the average by 58 minutes!
National D2B Goal is 90 minutes or less.
Most recent data reporting showed CMMC D2B time averaged 51 minutes!
What has happened since 2005?What has happened since 2005?
Whereas most PCI centers in 2005 could not reach D2B goals, 90% are now doing so.
We have engaged more community hospitals in our regular D2B meetings to enhance Door In Door Out strategies to facilitate transfers.
Whereas most PCI centers in 2005 could not reach D2B goals, 90% are now doing so.
We have engaged more community hospitals in our regular D2B meetings to enhance Door In Door Out strategies to facilitate transfers. In Door Out strategies to facilitate transfers. Goal is 30 mins or less.
EMS continues to monitor protocols and improve them. For example, we recently found that doing the field ECG in the patient’s house, saved nearly 10 minutes compared to doing it in the vehicle.
In Door Out strategies to facilitate transfers. Goal is 30 mins or less.
EMS continues to monitor protocols and improve them. For example, we recently found that doing the field ECG in the patient’s house, saved nearly 10 minutes compared to doing it in the vehicle.
What next?What next?Engage more regional hospitals to participate.Engage more regional hospitals to participate.Engage more regional hospitals to participate.
Local physician or nurse champions are indispensible.
Protocol development can be collaborative through our D2B team meetings.
Engage more regional hospitals to participate.Local physician or nurse champions are
indispensible.Protocol development can be collaborative
through our D2B team meetings.
Maintaining QualityMaintaining Quality
Monthly D2B meetingsInterventional Cardiology
Nursing
ED physicians
Monthly D2B meetingsInterventional Cardiology
Nursing
ED physiciansED physicians
Cath lab staff
EMS representatives
Transfer hospital representatives from St Mary’s, Rumford, Farmington, Bridgton, Parkview, others invited in person or conference call
ED physicians
Cath lab staff
EMS representatives
Transfer hospital representatives from St Mary’s, Rumford, Farmington, Bridgton, Parkview, others invited in person or conference call
D2B meeting formatD2B meeting format
Review any case outside the 90 minute goal, regardless of transfer status
Review any case outside the 90 minute goal, regardless of transfer status
Cath lab activation time
Depart mode and time
Arrival from transfer site
Cath lab arrival
Cath lab activation time
Depart mode and time
Arrival from transfer site
Cath lab arrivalstatus
Metrics reviewed:
Chest pain onset to 1st med contact
Hospital arrival time
Mode of arrival
Diagnostic EKG time
status
Metrics reviewed:
Chest pain onset to 1st med contact
Hospital arrival time
Mode of arrival
Diagnostic EKG time
Cath lab arrival
Balloon or device deployment time.
Modifiers delaying treatment: VF, respiratory, CPR, etc.
Cath lab arrival
Balloon or device deployment time.
Modifiers delaying treatment: VF, respiratory, CPR, etc.
Ongoing challengesOngoing challengesNew pharmacology
Alternative and competing strategies
Treatment of the post-CPR patient in coma
Hypothermia protocols and training
Additional community hospital support and involvement in QI process
New pharmacology
Alternative and competing strategies
Treatment of the post-CPR patient in coma
Hypothermia protocols and training
Additional community hospital support and involvement in QI processinvolvement in QI process
Cost effectiveness in a changing environment
Drug eluting stents in AMI?
Expensive transfers?
?Declining need? : Incidence of AMI declining and survival improving!
involvement in QI process
Cost effectiveness in a changing environment
Drug eluting stents in AMI?
Expensive transfers?
?Declining need? : Incidence of AMI declining and survival improving!
There is still no general agreement in Maine that every STEMI patient should go to the
There is still no general agreement in Maine that every STEMI patient should go to the STEMI patient should go to the
nearest PCI center!STEMI patient should go to the
nearest PCI center!
Why not? Can EMS play a role here?
Why not? Can EMS play a role here?
Achieving Rapid TreatmentAchieving Rapid Treatment
Diversion to the PCI center?Diversion to the PCI center?
Happening today, though unusual.
Challenges local resources.
Not appropriate for unstable patients or those with a questionable diagnosis.
Happening today, though unusual.
Challenges local resources.
Not appropriate for unstable patients or those with a questionable diagnosis.those with a questionable diagnosis.
May save ½ hour or more!
those with a questionable diagnosis.
May save ½ hour or more!
Think about this…Think about this…
In 2005, the CMMC Heart team recognized the competence, professionalism, and responsibilities of our regions EMS teams and empowered
In 2005, the CMMC Heart team recognized the competence, professionalism, and responsibilities of our regions EMS teams and empowered our regions EMS teams and empowered them to directly activate our cardiac teams while bringing patients rapidly to our PCI center in order to save precious minutes that we call “MINUTES OF MYOCARDIUM”…..
our regions EMS teams and empowered them to directly activate our cardiac teams while bringing patients rapidly to our PCI center in order to save precious minutes that we call “MINUTES OF MYOCARDIUM”…..
Now…Now…
Isn’t it time for our EMS services to extend to our Heart Team, the commensurate rights and responsibilities of displaying emergency flashing lights
Isn’t it time for our EMS services to extend to our Heart Team, the commensurate rights and responsibilities of displaying emergency flashing lights of displaying emergency flashing lights on our vehicles as attempt to get to the hospital promptly in order to definitively treat the patients you are transporting?
of displaying emergency flashing lights on our vehicles as attempt to get to the hospital promptly in order to definitively treat the patients you are transporting?
IS THIS AN EMERGENCYVEHICLE?
Special Thanks to the entire D2B team!Special Thanks to the entire D2B team!
The CMMC Cardiac Cath Lab staff! Their on call duties are incredibly demanding. They are the best!Our ED staff, physicians, nurses (especially!) and all their support staff.CMMC Connect for their invaluable help in facilitating transfers, communication, and quality reviews (everything is recorded!)All the EMS teams who are dedicated to helping their patients get
The CMMC Cardiac Cath Lab staff! Their on call duties are incredibly demanding. They are the best!Our ED staff, physicians, nurses (especially!) and all their support staff.CMMC Connect for their invaluable help in facilitating transfers, communication, and quality reviews (everything is recorded!)All the EMS teams who are dedicated to helping their patients get All the EMS teams who are dedicated to helping their patients get the best care!The Lifeflight crews whose commitment to excellent and rapid care is second to none.Our referring hospitals and their STEMI teams. We have seen them shine!Our Administrators who support the ongoing Quality Assurance.Our Database Team!
All the EMS teams who are dedicated to helping their patients get the best care!The Lifeflight crews whose commitment to excellent and rapid care is second to none.Our referring hospitals and their STEMI teams. We have seen them shine!Our Administrators who support the ongoing Quality Assurance.Our Database Team!
Prehospital Cath Lab ActivationThe Central Maine Experience
Prehospital Cath Lab ActivationThe Central Maine Experience
Kevin M. Kendall, M.D., FACEP
EMS and LifeFlight Director
Kevin M. Kendall, M.D., FACEP
EMS and LifeFlight Director
The End….The End….