On
the front page of Friday’s Chicago Tribune is Julie Deardorff’s story on
12-lead EKGs and the new STEMI system of care in Chicago that began on May 15th
of this year. The American Heart Association and its Mission: Lifeline
initiative are featured throughout the article, including quotes from Metro
Chicago Board immediate past president Dr. Stephen Archer and other key
experts who played a significant part in making this system a reality. It
includes powerful examples of Chicagoland patients who had life-saving outcomes
as a result of the system.
Special
thanks to Dr. Archer, Alex Meixner, Art Miller, Kathleen O’Neill, Mark
Peysakhovich and Julia Kersey with their rigorous behind-the-scenes work and
helpful guidance throughout the process of this story’s construction. Dr. Gary
Schaer, Dr. Richard Feldman, Dr. Atman Shah, John Easton and Leslee
Stein-Spencer, among others, also deserve and receive our extensive gratitude
for playing critical roles in this story.
Most
importantly, thank you to our outstanding volunteers and staff in Chicago who
played a significant part in the arrival and implementation of this vital
system.
The
story can be found here
(free registration required or Facebook log-in accepted) and full text of the
story is below.
City ambulances
finally equipped to detect severe heart attacks
Thanks to NATO
summit, people suffering 'widow-makers' can now be rushed to the right hospital
in time
By
Julie Deardorff,
Chicago Tribune reporter
July 20, 2012
Chicago's Brian Thies was at home
when the ache he'd been feeling all day suddenly turned into crushing chest
pain. Inside the ambulance, paramedics quickly determined he was suffering from
the deadliest type of heart attack, an aptly named "widow-maker."
The ambulance took him directly to
Rush University Medical Center, where a specialized team was expecting him in
the catheter lab. Just 40 minutes after the call to 911, Dr. Cliff Kavinsky
opened Thies' right coronary artery, which was 100 percent blocked.
Every minute counts during a
widow-maker, when blood flow is cut off in a major artery leading to the heart.
Until recently, Chicago ambulances
lacked a key piece of equipment used to diagnose the most severe heart attacks,
technically known as STEMIs. But thanks to creative funding and dogged health
officials, most of Chicago's 75 ambulances now carry the devices, called
12-lead electrocardiograms or EKGs.
Diagnosing a widow-maker in the
field — rather than at the hospital — can speed up treatment and dramatically
improve a patient's chances of survival. Not all hospitals have specialized
teams that can treat STEMIs around the clock, so it's essential that these
patients are taken directly to one that does. The new monitors also allow
paramedics to alert the hospital that a STEMI case is on the way, giving the
staff time to marshal resources.
"We've essentially extended
the hospital out to the community," said University of Chicago
cardiologist Stephen Archer, president of the American Heart Association's
Metro Chicago board of directors, who has been pushing for the STEMI system of
care for at least three years.
The Tribune reported in 2009 that
Chicago was one of the only major cities in the country whose emergency medical
responders did not have 12-lead EKGs, which provide a comprehensive picture of
the heart's electrical activity. Instead, the city's ambulances used three-lead
EKGs, which can pick up an irregular heartbeat but don't have the depth to
diagnose a STEMI, short for ST-Elevation Myocardial Infarction.
Fire officials say that although
they were eager to get the equipment, patient care was not being compromised.
Some health officials disagree.
"It was a big problem,"
said Dr. Richard Feldman, a medical director for part of the city's Emergency
Medical Services system who is based at Advocate Illinois Masonic Medical
Center. Chicago was "way behind the curve" in terms of instituting a
program of care for STEMI patients, he said.
"There wasn't sufficient will
on the part of the city to elevate this to a higher priority," said Dr.
Gary Schaer, an interventional cardiologist at Rush University Medical Center.
Schaer, co-chair of a regional STEMI advisory committee, met with the heart
association and the mayor's office multiple times to lobby for the 12-lead
EKGs. "It was very frustrating," he said.
Officials had estimated that $3.2
million would be needed to buy 100 of the 12-lead devices, said Leslee
Stein-Spencer, the Fire Department's manager of medical administration and regulatory
compliance.
In the end, Chicago's role as host
city for May's NATO summit opened up an unexpected source of grant money. To
help bolster the city's emergency response capability, the Fire Department was
allowed to buy the equipment with funding from theU.S. Department of Homeland
Security, at a cost that turned out to be far lower than predicted.
In addition to the new monitors,
Chicago's STEMI system includes a network of 25 hospitals in and near the city
that are designated as STEMI-centers. At these hospitals, specialized teams are
available 24/7 to open the blocked artery within about 90 minutes of arriving
at the hospital.
The STEMI network also includes a
new system for tracking severe heart attacks as well as quality control
guidelines established by the American Heart Association as part of a national
initiative to improve heart attack care called Mission: Lifeline. About 60
percent of the nation, including many Chicago suburbs, is now covered by a
similar STEMI network, Archer said.
Each year, nearly 300,000 people
in the U.S. and 1,500 Chicagoans experience a STEMI, according to the American
Heart Association, which has made improving care for STEMI heart attacks a
national priority.
The most effective treatment
involves angioplasty, or clearing the blockage by opening the artery using a
small balloon. A type of scaffolding called a stent is then inserted to prop it
open.
Archer said the survival rate for
STEMI patients is more than 95 percent when the "door to balloon"
time is less than 90 minutes. The term refers to the period between the
patient's arrival in the emergency room and the moment blood flow is restored.
If that window is missed, the patient has a nearly 50 percent chance of dying.
In the past, Chicago's EMS teams
routinely took heart attack patients to the closest hospital. But not every
hospital can perform a balloon angioplasty around the clock, Archer said. If
the STEMI is diagnosed at a hospital that can't perform the procedure, the
patient must be transferred, a costly and potentially life-threatening delay.
After the Tribune's 2009 article,
the American Heart Association convened a board meeting to start laying the
groundwork for a new system of care, even though the funding wasn't yet
available.
The committee, which included members
of the Fire Department and EMS officials, spent a year designating which
Chicago-area hospitals are equipped to take STEMI patients. It also hammered
out specific ground rules. STEMI hospitals, for example, can't divert patients
just because they are busy.
Meanwhile, fire officials
discovered they could upgrade the current monitors to 12-lead capability by
buying software and the 12 leads for far less than the original $3.2 million
estimate. Once the funding finally materialized, the city spent $800,000 on 100
monitors, which includes equipment for the current fleet of 60 front-line
ambulances as well as special event ambulances and spares, said
Stein-Spencer.
The first STEMI transport was made
May 15, five days before the NATO summit, when a 52-year-old man was taken to
Vanguard West Suburban Medical Center in Oak Park, the closest STEMI hospital.
He was treated with angioplasty and has recovered, hospital officials said.
Since then, 167 STEMI transport
cases have been reported, Stein-Spencer said. One of them was Joyce Martin, who
woke up in her Bronzeville home July 4 with indigestion and shortness of
breath. Martin, 66, thought it was gas. Instead, the paramedics determined it
was a widow-maker.
Bypassing a closer hospital, the
ambulance took her to the University of Chicago medical center, a designated
STEMI location, said Dr. Atman Shah, director of U. of C.'s coronary care unit.
"She came right to the ER, and our team of physicians was waiting at the
door," he said. "Within 70 minutes, we'd opened up her artery."
Thies, a 32-year-old graduate
student, was getting ready to head out for an afternoon class two weeks ago
when his chest pain intensified. He couldn't breathe, sit or stand. He called
911, but it didn't cross his mind that he was having a heart attack until a
paramedic told him.
"I thought it was a
respiratory issue because I had trouble breathing," he said.
Despite having a key artery
completely blocked, Thies went home with normal heart function, doctors said.
He has already returned to his business classes at the University of Illinois
at Chicago.
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