Objectives. Howard County STEMI History 3/1/2013. Serious As a Heart Attack Optimal STEMI Care through Hospital/EMS Partnership & Feedback
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1 Serious As a Heart Attack Optimal STEMI Care through Hospital/EMS Partnership & Feedback Kevin G. Seaman, M. D., FACEP Medical Director Howard County Dept. of Fire and Rescue Objectives Describe partnership between hospital and EMS/Fire Review STEMI Program History Describe current STEMI Program including MD EMS system (Statewide protocol, Hypothermia, CIC) Introduce the Resuscitation Academy Experience with Sudden Cardiac Arrest (SCA) Howard County STEMI History 1994 EMS Task Force 1996 Howard County DFRS 12 Lead ECG Program Analog modems transmit to Medical Base Station 2007 Describe Coronary Intervention Center Experience with post-rosc patients Maryland Medical Protocols Field Identification of STEMI 1
2 Referral to a Cardiac Intervention Center (CIC) Consultation via Radio to ED Neuroprotective Induced Hypothermia (Therapeutic) after Cardiac Arrest OUR PARTNERSHIP Howard County General Hospital Howard County Dept. of Fire and Rescue Services Statewide mandatory protocol as of July 1, 2012 OUR CURRENT STEMI SYSTEM LIFENET STEMI Notification 2005 HCGH approved as a PAAMI site State waiver from regulation 2006 HCGH request to partner to improve DTB times for STEMI patients Elements Field 12 lead ECG identification of STEMI Field consultation activates the cath lab team PRIOR to patient arrival Feedback Cardiology education in ALS continuing education sessions 2
3 Howard County STEMI Alert Feedback STEMI Packet DFRS Review of Care STEMI System Performance 2011 data 98 PCI cases Average DTB of 72 minutes Field provider-identified STEMI taken to cath lab 80% Simultaneous Processes Improve Patient Outcomes Field 12 lead Transmission ED Arrival Cath Lab Activation To Cath Lab Consult: Cath Lab Activation PTA Field 12 lead Transmission ED Arrival To Cath Lab 3
4 IAFC Heart Safe Community Award WELCOME TO CARES 2012 Many Thanks to Our Sponsors for Making This Possible! THE RESUSCITATION ACADEMY Four Things to Remember Measure Performance Feedback is Essential Slides/Concepts Courtesy of Dr. Mickey Eisenberg and the faculty of Many ways to accomplish feedback You re the expert on your system Select the method that works best for you Importance of Feedback What others think of what we re doing $1 What we think of how we re doing $10 What the data shows we re doing. $1,000. Feedback to providers PRICELESS 4
5 Emergent PCI for Resuscitated Victims of OOH Cardiac Arrest More aggressive approach to post resuscitation care = better outcomes Immediate induction of mild therapeutic hypothermia for all resuscitated victims who remain comatose Early coronary angiography and PCI Evidence of STEMI on post resus. ECG Combining therapies: 70 80% neurologically intact survival Even those without STEMI on post resus ECG can benefit Kern KB, Rahman O. Cardiovasc Interv Mar 1;75(4): Optimal outcome for Patients Surviving OOH Cardiac Arrest Post resuscitation Systemic ischemic/reperfusion insult Therapies affecting neuro intact survival Mild therapeutic hypothermia Early PCI Which patient has an occluded/unstable artery? Not predicted by Symptoms, nor ECG Resuscitated victims without obvious noncardiac etiology should undergo cath and PCI. Kern KB JACC Cardiovasc Interv Jun;5(6): Experience with Post-ROSC Patients High Performance CPR Order HCGH STEMI Program HCDFRS Post-ROSC Edit to CRM Order Not that serious! Questions? 5
6 Summary The most effective therapy occurs when there is teamwork between prehospital and hospital providers including feedback Cardiovascular disease is a spectrum including STEMI and Sudden Cardiac Arrest Maryland has a statewide system to identify and treat these patients and deliver them to a network of Cardiac Intervention Centers An aggressive approach including mild TH and PCI, where indicated, provides the best survival benefit for these patients 6
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