Island hospital, paramedics fight back against heart attack

tbarton@islandpacket.comJanuary 21, 2012 

Area paramedics are using new tools to help victims of serious heart problems survive and recover.

The procedures and equipment allow vital data to be transmitted to Hilton Head Hospital at the same time patients are being tended by paramedics. Doctors at the hospital, armed the data they've reviewed before the patient arrives, are prepared to treat them immediately.

The new procedures save crucial time, allowing doctors to restore blood flow to the heart more quickly.

Several hospitals in the state have started the procedures as part of a national initiative pushed by the American Heart Association to improve care for heart attack patients.

"We are making it our explicit goal to save more patients on Hilton Head Island," said Capt. Tom Bouthillet, a paramedic with Hilton Head Island Fire & Rescue Division. "We are taking ownership of the chain of survival with methodical steps to improve our survival rate."

In addition to transmitting data on heart attack patients to the hospital before they arrive, the Fire & Rescue Division and the hospital recently began using another procedure -- induced hypothermia -- to treat patients experiencing cardiac arrest.

The body-cooling technique has proven effective in saving lives and preventing neurologic damage after cardiac arrest, officials say. Cooling the body stops inflammation in the brain and slows a patient's metabolism, allowing the brain time to rest.Here are more details on the two new procedures:HEART ATTACK PROTOCOL

Heart attacks occur when an artery supplying oxygen-rich blood to the heart becomes blocked, causing the death of at least some of the heart muscle.

A heart attack can be recognized by changes shown on an electrocardiogram, said cardiologist Dr. Jay M. Kalan. The ECG, when administered in the field by paramedics, tells doctors at the hospital how extensively the patient's heart has been damaged. The doctors, in turn, can prepare a treatment protocol tailored to the patient's needs as paramedics rush the patient to the hospital.

"This activates a whole process at the hospital, where the cath lab (and) the cardiologist comes in and the ER is alerted," Kalan said. "The goal is for the cath lab staff and MD to be ready when the patient hits the ER (if during working hours), or to be on their way to the hospital as the patient is being transported by EMS."

Doctors use a catheter -- a thin wire inserted in a large artery and run up to the artery where blood flow has been obstructed. Tiny devices are attached to the end of the catheter and used to reduce the size of the blockage and restore blood flow.

The American Heart Association and American College of Cardiology have set a goal of 90 minutes elapsing from when paramedics arrive to help a patient to the time doctors at the hospital begin working on the blocked artery.

The sooner, the better, "because time is muscle," Bouthillet said.

With the new protocols in place, Hilton Head Hospital achieved a response of less than 90 minutes 100 percent of the time last year, according the hospital.

INDUCED HYPOTHERMIA

Many heart attack patients return to full, productive lives with early treatment. The same, however, cannot be said for cardiac arrest, when the heart goes into a rhythm that doesn't circulate blood to the brain and other organs.

Less than 5 percent of cardiac arrest patients improve to the point of being functional after discharge, Kalan said.

To improve the odds, Hilton Head EMS and hospital staff are putting patients on ice -- turning a potentially life-threatening scenario into a brain-saving opportunity.

"Children who drown in cold water were found to have a higher rate of return to normal brain function, even if submerged for relatively long periods of time," said Dr. Robert Clodfelter, medical director of emergency services at Hilton Head Hospital.

The same applies to people suffering cardiac arrest, according to the heart association. The cooling reduces inflammation in the brain, preventing further damage.

"Hypothermia in the outdoors is uncontrolled, and the temperature can get dangerously low," Clodfelter said. "We use a device that lowers the (body's) temperature ... enough to slow metabolic processes, but not cause damage to tissues."

The process begins in the ambulance when the patient is given an intravenous cold saline solution and has ice packs placed around the groin, neck and in the armpits. At the hospital, special cooling wraps are placed on the patient's body that circulate iced water to manage his or her temperature.

The process is used on patients who have responded to CPR and effort's to shock the heart back to normal rhythm but have yet to regain consciousness.

Patients are cooled to 91.4 degrees Fahrenheit for 24 hours, then slowly re-warmed and allowed to wake up. The body's normal temperature is 98.6 degrees Fahrenheit.

The cooling allows the injured body to recover. The goal of the therapy is to preserve vital organs, especially the brain, and improve the patient's cognitive and motor functions, Kalan said. The technique allows the patient to cover more fully.

Follow reporter Tom Barton at twitter.com/EyeOnHiltonHead

Related Content:

American Heart Assocition, Mission Lifeline

Hilton Head Hospital

Town of Hilton Head Island Fire & Rescue Division

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