Saving Heart Attack Patients in the Middle of the Night

When Joyce Moss recently arrived at Loyola University Hospital with a life-threatening heart attack, it took just 42 minutes to perform an emergency balloon angioplasty.

The procedure opened up an artery that was 100 percent blocked. "There was no damage to the heart because of how quick they were," said Moss, 56, of Berwyn. "I feel good."

To further improve its emergency angioplasty times, Loyola will become the first hospital in Illinois to staff a Heart Attack Rapid Response Team (HARRT) at the hospital 24 hours a day, seven days a week. The HARRT program includes board-certified and highly-experienced interventional cardiologists, nurses and technicians.

Most hospitals do not have such personnel on site during nights and weekends. Thus, precious time is lost when the team has to be called in from home. This is especially true when staffers are delayed by snow storms or other bad weather.

"The HARRT program will provide the next leap of care for patients," said Loyola interventional cardiologist Dr. Fred Leya. Leya is among a team of interventional cardiologists who will rotate night and weekend shifts at the hospital. Leya is medical director of Loyola's cardiac catheterization lab.

Reducing angioplasty times is a coordinated effort that begins with paramedics who take patients to the hospital. There are 51 west suburban fire departments and ambulance companies in the Loyola Emergency Medical Services System. A growing number of ambulances are being equipped so that paramedics can administer 12-ead EKG exams while en route to the hospital. An EKG can confirm a heart attack, and results are radioed ahead to the hospital, said Dr. Mark Cichon, Loyola's director of emergency medical services.

Once a heart attack is confirmed, it takes less than five minutes to prep the patient. The interventional cardiologist then threads a catheter (thin tube) from an artery in the groin to the heart. The cardiologist inflates a balloon at the tip of the catheter to open the artery. In many cases, the cardiologist places a stent (wire mesh tube) to keep the artery open.

The doctor must be fast and accurate. "You become very focused," said interventional cardiologist Dr. Bruce Lewis. "It's like shooting a three-pointer with two seconds to go, except that you can't afford to miss." Lewis is a professor in the division of cardiology at Stritch.

Experience helps improve outcomes. Interventional cardiologists on the HARRT team each perform approximately 300 angioplasties per year. "We have seen just about every permutation," Lewis said.

A task force of the American College of Cardiology and American Heart Association recommends that a patient undergoing a heart attack receive a balloon angioplasty as soon as possible or at least within 90 minutes of arriving at the hospital - known as the door-to-balloon time. Speed "is of central importance because the benefits of therapy diminish rapidly with delays in treatment," the task force said in a November, 2008 statement published in the heart association journal Circulation.