The faster a heart attack patient can get to the cath lab, the better. CMMC has put the pedal to the metal.

LEWISTON – The New England Journal of Medicine has started recommending – as vigorously as it can – rapid transit of heart attack and potential heart attack patients to the cath lab.

The Central Maine Heart and Vascular Institute at Central Maine Medical Center is already doing that, having instituted this healthy protocol well before many hospitals across this country.

And, according to Tom Judge, executive director of Lifeflight of Maine, it’s giving central and western Maine’s cardiac patients a better chance of survival.

CMMC and CMHVI are way ahead of the rest of the state in employing faster transport procedures, he explained, by taking their success in treatment of trauma and dissecting each one of those steps, and then “systemizing that for what we do with cardiac patients,” Judge explained, which is “really good news for that community.”

CMHVI’s expedited process, which required intensive training of paramedics and emergency medical technicians in the field, is straightforward.

Paramedics and EMTS in Poland, Turner, Lisbon and with United Ambulance have been trained to interpret EKGs – electrical activity of the heart – in the field and are empowered to activate the cath lab at CMHVI without a doctor’s order. That means the cath lab starts prepping for rescue angioplasty even before a patient arrives at the hospital. The process shaves vital minutes off transport time, which Dr. Kevin Kendall – who directs CMMC’s emergency medical services and is medical director for LifeFlight – said allows CMHVI to have the best “door-to-balloon time in the state.”

“Our goal is to get arteries open within 90 minutes,” according to Dr. William Phillips, medical director of cardiology at CMHVI. Nothing, he said, “beats the feeling of stopping a heart attack in its tracks,” delivering a cardiac patient the best possible chance of survival.

The New England Journal of Medicine’s Nov. 13 recommendation to the nation for in-the-field activation of the cath lab comes 16 months after the process was put in place in Lewiston. According to Kendall, there have been 15 to 20 cases since July 2005 in which local paramedics identified a heart attack victim in the field, activated the CMHVI cath lab and expedited angioplasty, including six cases in the past month.

Coincidental to the Journal of Medicine recommendation, the Maine Quality Forum recently announced a new initiative called “In a Heartbeat,” designed to draw the state’s cardiac centers together on the best procedures to “ensure heart attack victims receive timely and quality care, regardless of where they are afflicted and where they are treated.”

Outside these recommendations and initiatives, cardiac physicians still say the best way to increase speedy treatment is to learn to identify cardiac symptoms and call for an ambulance if you believe you’re having a heart attack. Kendall estimates that about 80 percent of cardiac patients are still driving themselves to the hospital because they’re not sure their symptoms are deadly. When patients do that, Kendall said, they’re putting themselves in danger. “You can give yourself an aspirin,” he said, “but you can’t put an IV in,” which is something paramedics and EMTs can do.

Time, as cardiac docs like to say, is muscle. The faster patients get in the OR, the less heart muscle is destroyed. Faster is always better.

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