CODE HEART Door to Lab William O Suddath
“CODE HEART” Door to Lab William O. Suddath, M. D. Director, Interventional Cardiology Fellowship Washington Hospital Center
Evolution of Percutaneous Coronary Intervention 1 st PTCA NHLBI-PTCA Reg #2 n=1802 FDA Approval -USCI -ACS HFICA Approval NHLBI-PTCA Reg n=3079 FDA Approval-Cordis FDA Approval DES Cook Stent-bail out CMS Approval DES JJIS stent-elective HFICA Approval Stent Brachytherapy Clinical Trials -Dir Atherectomy -Stent -Rotablator -Excimer Laser FDA Approval ACS Multilink BSC Approval TAXUS
AIM: Scope of the Problem 2010 Over 3, 500, 000 Patient Admissions 1, 000 STEMI 750, 000 ST Depression MI 750, 000 T wave Change MI
Goals: 5 min Media campaign Patient education Within 30 min D-N within 10 min D-B within <60 min Methods of Speeding Time to Reperfusion Prehospital ECG to initiate Rx Greater use of 9 -1 -1 Prehospital Rx MI protocols Critical Pathway Quality Improvement Programs Bolus Lytics Dedicated In House PCI Team With 60 minutes to presentation, D-N or D-B should not exceed 10 / 30 minutes.
Door To Balloon Times
Acute Inferior Wall Myocardial Infarction Morris, F. et al. BMJ 2002; 324: 831 -834 Copyright © 2002 BMJ Publishing Group Ltd.
Relationship Between Myocardial Salvage and Survival 100 Mortality reduction (%) 80 Median U. S. Sx-ER: 2° 60 Lytic given: 30’ % 40 Median U. S. PCI Sx-bal: 3. 5° • Collaterals • Ischemic preconditioning • MVO 2 Lytic works: 60’ 20 0 Modifying factors Extent of salvage (% of area at risk) Hours 1 Gersh B. JAMA 2005 3 6 12 24 Treatment objectives Time to treatment is critical Opening the IRA (PCI > lysis)
Time Is Myocardium and the Wavefront of Necrosis CM Gibson 2002
Design Sketch Removes Oxygenated blood from LA Returns blood through the FA 21 F Inflow 14 -17 F Return Flow: 2 -3. 5 L min Pressure Sensor 1. 2 mm RF Transmitter 1. 5 mm Post MI CS survival = 43. 8%
Goals: 5 min Door to ECG Within 5 min Cath Lab Transport complete <10 min Cath Lab Prep < 10 Min PCI complete < 10 min Cath Lab Team Diagnosis and Activation of Code Heart Continuous Monitoring of Methods to Speed Time to Reperfusion Post PCI Care AMI protocols Surgical Considerations Critical Pathway Shock Quality Improvement Complications Programs Dedicated In House System Success cannot be achieved without the support of the entire system… EMS, ED, Cardiology, Administration.
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Med. STAR Transport Washington Hospital Center Washington, DC
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