Dr Ranjit More PPCI Lead, LCC 18 th September 2012
AGENDA 9: 40 : PPCI Case Study Dr Sunita Pillay, Cardiology Spr 9:50: A Cardiac Network Perspective Kathy Blacker, Director CSNLC 10:00: NWAS Perspective Mary Peters, Clinical Governance Co-ordinator NWAS 10:20 10:45 : Coffee Break 10:45 11:00: National Perspective: Dr Jim McLenachan, National Clinical Lead for PPCI 11:00-11:20: Regional PPCI the first 12 months 11:20-11:45: Rehab for PPCI - Lisa Schofield, Cardiac Rehabilitation Specialist Nurse PPCI follow-up clinic Louise Charnley, Nurse Advanced Practitioner 11:45 : Q & A
ST segment elevation MI (STEMI) - Characterised by specific ECG changes due to total occlusion of a coronary artery. PPCI involves reopening mechanically of the occluded artery by balloon catheter and deployment of a stent
Thrombectomy catheter - Often used, in addition, to aspirate thrombus from the vessel occlusion site
PPCI Procedure Start Mid End result Vessel Occluded in its Proximal Portion Reopened Vessel
Benefits of Primary Angioplasty over Thrombolysis PPCI lowers mortality and improves longer-term symptoms & outcomes. In-hospital mortality for patients undergoing PPCI was 5.2% and 7.1% for those given thrombolysis (NIAP report 2008) Also fewer strokes and recurrent heart attacks during the hospital admission Patients who were admitted directly to the catheter laboratory bypassing A & E departments had the lowest mortality. The greatest delay in treatment is the time taken for patients to recognise the problem and call for help Therefore need systems in place to minimise delay (TEAM EFFORT: NWAS, local A& Es, local cardiologists/physicians, public health, local councils, local press)
Background to regional PPCI Regional PPCI for Lancashire & South Cumbria planned from 2008 PPCI implementation was an important and integral part of the revascularisation portion of the 5 year strategy for cardiac services of the Cardiac & Stroke Networks in Lancashire and Cumbria Commissioner sign off for PPCI : end of 2010 Regional PPCI service started June 2011
Detailed modelling done Ambulance travel time isochrones PCT financial modelling Close liaison with NWAS Additional beds & staff on CCU, wards and cath lab
Local (Blackpool) PPCI Commenced 2009 : To ensure appropriate infrastructure and systems in place for seamless transition to regional PPCI Allowed development and modification of protocols for PPCI patients at LCC NWAS staff to become familiarised with delivering PPCI patients to LCC
PPCI Operational Model Since 5th June 2011 all patients experiencing a STEMI within the network catchment area are transported straight to the Heart Attack Centre at LCC to receive a PPCI. This includes four Acute Trusts across seven geographical sites: Royal Blackburn Hospital Royal Preston Hospital Chorley and South Ribble Hospital Royal Lancaster infirmary Furness General* West Cumberland Hospital Blackpool Fylde and Wyre hospitals Foundation Trust Drip & Ship arrangements A performance target of 150 minutes has been applied to monitor Call to balloon time ( NIAP report stipulated that PPCI is a cost effective and appropriate intervention provided PCI related delay is minimised (kept to < 90mins))
PPCI Pathway Call for ambulance / self referral / referred as an inpatient from DGH.* * Drip & Ship for FGH patients Transfer to LCC: Target <150 minutes from call to Balloon insertion. Balloon inserted, patient transferred to Coronary Care Unit. Patient remains on Coronary Care Unit, for 6-24 hours Patient transferred to cardiology wards. Follow-up: Local hospital Patient discharged 72-96 hours after admission.
After PPCI procedure A treat and discharge model of care In-patient: Advice from CCU nurses & doctors Seen by cardiac rehab staff lifestyle advice Pharmacist medication advice On discharge Referral to local cardiac rehab service PPCI nurse specialist follow-up clinic at approx 2 weeks Cardiology clinic follow-up local
Patient Experience John Stevenson, aged 64 from Lancaster was the first regional patient to receive a PPCI at Lancashire Cardiac Centre. The ambulance crew were called and before I knew it I was in Blackpool having an operation. The speed of the whole process was remarkable, everyone knew what they were doing and just got on with it, it was like a military operation and everyone involved was outstanding. I can t believe I had a heart attack a couple of days ago. I feel so good and I can t thank everyone at Lancashire Cardiac Centre enough.
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