Program plans to speed up heart-saving procedures, but not all area hospitals on board

LEWISTON — Three of Maine's four heart centers, including Central Maine Medical Center, have surpassed the national average in a key measurement known as "door-to-balloon" time.

The balloon is an emergency angioplasty, the heart-saving procedure that slides a tiny balloon-tipped tube into an artery and restores blood flow. If it's done quickly enough, permanent damage to the heart muscle can be limited or even prevented.

Nationally, the goal is 90 minutes or less. A new study of cardiac centers is finding that 90 percent of heart attack patients are now receiving the treatment within the goal. From 2005 to 2010, the median time from hospital admission to angioplasty has declined from 96 to 64 minutes, according to the study to be published in the Journal of the American Heart Association.

Three of Maine hospitals do better than the 64 minutes.

Maine Medical Center in Portland recorded a median of 53 minutes in 2010, said a spokeswoman. At York Hospital, a spokeswoman there described an average time of 69 minutes. At Eastern Maine Medical Center in Bangor, Dr. Peter Ver Lee cited a median time of 51 minutes.

And at Central Maine Medical Center, the median time was 52 minutes, said Dr. William Phillips, a cardiologist at the Lewiston hospital. 

"Our time is very, very good," Phillips said. "And it has been."

Response time has been carefully monitored at CMMC for years, Phillips said. When the hospital's heart and vascular institute was created several years ago, it was designed with speed in mind. It even factored in the hiring of its emergency catheter lab staff, who must live no further than 30 minutes from the hospital.

More recently, though, CMMC and other hospitals, including Eastern Maine Medical Center, have turned their attention outward, in an effort to find more minutes for heart patients.

"We're trying to get people to buy into the process," Phillips said. Every minute saved can result in a healthier heart in the end, potentially saving lives.

CMMC is working with other hospitals and area paramedics. They are establishing rules for where heart patients must be taken during an attack. And they are training professionals to perform electrocardiograms while still in the ambulance. The EKG can discern between several problems, including a blocked artery.

In Lewiston, a monthly door-to-balloon group meets to examine every single case in the area. Besides doctors and nurses from CMMC, people attend from St. Mary's Regional Medical Center in Lewiston, LifeFlight and other ambulance services, Parkview Adventist Medical Center in Brunswick and elsewhere.

The group picks apart each visit, discussing ways to speed people through the process, from the pickup by ambulance to the arrival at the ER to the notification of Phillips and his colleagues.

"We pick apart each little segment of time," he said. He believes the biggest savings can be found at the start of the process, before the patient arrives at the hospital door.

But not everyone is part of the discussion. Some local hospitals, such as Franklin Memorial Hospital in Farmington, have been invited but do not attend, Phillips said.

It leaves a murky area for everyone, he said.

Just as universal hospital policies dictate that trauma victim's need to go to the nearest hospital, most people having a heart attack ought to head for the nearest heart center, Phillips said.

It's a discussion that's not only happening in Lewiston-Auburn and its nearby hospitals.

Ver Lee, a doctor at Eastern Maine Medical Center, said he and others are working on policies for its area hospitals.

"But, it's political," he said.

For instance, if someone in Ellsworth has a heart attack, they typically go to Maine Coast Memorial Hospital in Ellsworth. There, the person is diagnosed and, if needed, sent on to Eastern Maine Medical in Bangor, 30 minutes away.

The whole time, lack of blood flow may be weakening the heart, Ver Lee said.

If an EKG can be done by paramedics in the ambulance, hopefully determining whether there is a blockage, the patient could be taken directly to the heart center in Bangor.

It might save lives, Ver Lee said.

"More heart muscle is preserved," he said. "Your risk of dying is lower."

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Norman Rust's picture

Door to Balloon

I am glad to see this plan being worked on. As a former EMT and heart patient I can see the value of going to the nearest heart center once a blocked artery has been determined via EKG.

 's picture

This process was Emergency

This process was Emergency Medical Services driven from the start. There were two systems in place a full three years before Lewiston, Portland and Bangor. (MMC,CMMC,EMMC) That was Western Maine Health care in Norway. And Delta Paramedics in Waterville. The Heart centers were wonderfully surprised after the ER Doctors and Paramedics (not from lewiston, Portland, Bangor) were diagnosing "Heart Attacks" in the field. The impetus for this was developed in Missouri by a Paramedic instructor who developed a program for paramedics to accruately diagnose this disease early. The delay and the counting of minutes was developed, and then in this paper, the cardiologists were happily surprised at the accuracy in which paramedics could diagnose these events, four years after paramedics had been certified to do so. This unique approach was developed by a couple of very astute ED doctors and nurses, not from Lewiston Bangor, and Portland, long before the institutes co-opted the idea.


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