ECG Transmission By Cell Phone Speeds Heart Attack Treatment

An emergency room physician reviews the ECG and, if the patient ishaving a heart attack, calls in the cardiac catheterization team evenbefore the ambulance arrives at the hospital. The result: The patientis immediately whisked to the cardiovascular cath lab, where aninterventional cardiologist opens the blocked coronary artery,restoring blood flow to the heart.

"Time is muscle. The more quickly we can get the artery open,the less heart muscle will be damaged," said Dr. Shukri David, chief ofcardiology at Providence Hospital in Southfield, Mich. "We'remobilizing the cath lab team while the patient is still at home."

Traditionally, paramedics perform an ECG in the field if theysuspect a patient is having a heart attack but do not transmit thetracing to the emergency room. Instead, patients are triaged andevaluated in the ER, and only then is the cath lab team called in tothe hospital.

By basing treatment decisions on the ECG performed by paramedics in thefield, physicians at Providence Hospital have been able to cut to 44minutes the average time from patient arrival at the hospital toinflation of the angioplasty balloon that opens the blocked artery(so-called door-to-balloon time). In the past, it took an average of 88minutes to restore blood flow to the heart.

The early triage system is not costly to set up, Dr. Davidsaid. In addition to conventional cell phones, it requires thatambulances be equipped with monitoring equipment capable of generatinga standard 12-lead ECG and that the emergency room be equipped with acomputer station to receive ECG data, convert it to a digital tracing,and generate a hard-copy print-out.

In addition, to ensure a rapid response, Providence Hospital requiresthat cath lab staff either live within 30 minutes of the hospital orremain at the hospital when on-call.

"When a patient is having a heart attack, the cath lab team needs to be there right away," Dr. David said.

Headquartered in Bethesda, Md., the Society for CardiovascularAngiography and Interventions is a 3,400-member professionalorganization representing invasive and interventional cardiologists.SCAI's mission is to promote excellence in invasive and interventionalcardiovascular medicine through physician education and representation,and advancement of quality standards to enhance patient care. SCAI wasorganized in 1976 under the guidance of Drs. F. Mason Sones and MelvinP. Judkins. The first SCAI Annual Scientific Sessions were held inChicago in 1978.