Doctors study bypass of ER

From the Chicago Tribune: http://www.chicagotribune.com/health/sc-nw-heart-attack-0723-20100723,0,6976536.story

For heart attacks, quick care at lab may save lives

By Maura Lerner and Josephine Marcotty, McClatchy/Tribune news

July 23, 2010

MINNEAPOLIS —

If you're having a heart attack, you may not need an emergency room at all, according to a new study.

Researchers found that patients receive faster care, and are more likely to survive, if an ambulance crew takes them straight to a specialized hospital "cath lab," where doctors can act quickly to open their blocked arteries.

So far, only a fraction of hospitals use this system, which relies on specially trained paramedics to diagnose heart attacks without emergency room staff.

But the study, led by Dr. Kenneth Baran, a heart specialist at United Hospital in St. Paul, Minn., suggests that the process can cut the time needed to treat the most dangerous heart attacks from an average of 81 minutes to 36 minutes, and vastly improve the chances of recovery.

"Our times were phenomenal," Baran said. In some cases, "we had patients in with their artery open in 20 minutes."

In the study, published in the July issue of Circulation: Cardiovascular Quality and Outcomes, Baran's team also found that patients who went directly to the catheter lab were less likely to die in the hospital (3.9 percent) than those who came through the emergency room (7.5 percent).

Experts say that the minutes after a heart attack are crucial because muscle starts to die when oxygen is cut off. If the blockage can be cleared within 60 minutes or so, the heart attack may cause little permanent damage, they say.

Despite the study results, some experts warn that certain patients might need extra testing to rule out pulmonary embolism or other conditions.

"You have to be careful if it's not straightforward," said Dr. Alice Jacobs, a cardiologist with the Boston Medical Center and an adviser to the American Heart Association.

At first, some cardiologists who perform the catheter procedures were skeptical, Baran said, worried that they would face more false alarms and have to act as both emergency-room doctor and heart specialist. But when the results were so positive, he said, they became more accepting.

Timing: Hospitals strive to treat a heart attack patient within 90 minutes of arrival — frequently with an inflatable catheter to open blockages. By taking patients directly to a "cath lab," many have cut that time in half.