STEMI/STROKE BOOT STEMI/STROKE BOOT CAMPCAMP

“Time is Muscle”Paul T. Frantz, MD

Medical Director, Cardiac Services

Carilion Clinic

Agenda

• “Time is Muscle” – what is the science behind this statement

• Case Reviews – with ‘take home’ messages

• Q & A

Full Disclosure Statement:Dr. Frantz receives no reimbursement from any of the

companies or products sited in his presentation

Atherothrombosis: Thrombus Superimposed on Atherosclerotic

Plaque

Adapted with permission from Falk E, et al. Circulation. 1995 ;92:657-671.Adapted with permission from Falk E, et al. Circulation. 1995 ;92:657-671.

Slide reproduced with permission from Cannon CP: Atherothrombosis slide compendium; www.theheart.orgSlide reproduced with permission from Cannon CP: Atherothrombosis slide compendium; www.theheart.org

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Treatment Delayed is Treatment Treatment Delayed is Treatment DeniedDenied

Antman EM et al. Circulation, 2004Antman EM et al. Circulation, 2004

Symptom Recognition

Call to Medical System

EDPreHospital

Delay in Initiation of Reperfusion Therapy

Increasing Loss of Myocytes

Cath Lab

Normal Right Coronary Arteriogram

Case # 1“When all the stars are aligned”

• 54 y.o male with sudden onset chest pain before going to work

• Called 9-1-1, Fort Lewis crew responded

• c/o nausea, vomiting, right shoulder pain

• Cool and diaphoretic; BP 90/40 P 56 (weak)

• Loaded & IMI identified on 12 lead EKG

• Field Heart Alert called “ETA 10 minutes”

Field EKG @ 8:04 AM

Time Sequence for Case # 1Dispatched 7:52

Arrived at Scene 7:56

Arrived at Patient 7:57

Field EKG 8:04

Transport 8:07

Heart Alert Called (“ETA 10 min”) 8:23

Arrived at CCL (direct admit) 8:35

Balloon Time 9:01

Door to Balloon Time 26 minutes

EMS Contact to Balloon Time 64 minutes

Cardiac Catheterization/PCI

Normal Left Coronary Arteriogram

Case # 2“Reinforcing That Time is Muscle”

• 61 y.o. male (R.M.) c/o severe c.p. beginning about 4:30 PM

• Called 9-1-1 after 5:00 and CPTS ground crew requested LG 10 on standby

• Clinical presentation and12 lead by ground crew suspicious for MI (rapid AF with wide complex QRS); LG 10 launched

• Given ASA, NTG, adenosine and fluid bolus• Repeat 12 lead suspicious for MI and pt transferred to

CRMH by air• Remained hypotensive (100/72) with rapid, weak pulse

during transport• After evaluation in ED, Heart Alert called

CPTS 2nd EKG on ground

CPTS 1st EKG on ground

CPTS 1st EKG on ground

LG 10 EKG while in air

Time Sequence for Case # 5

Standby Request for LG 10 17:20

Launch Request 17:55

Lift off 17:59

Arrive at Scene 18:23

Transport 18:34

Arrive CRMH 18:50

Arrived at ED 19:00

Heart Alert called 19:30

Balloon Time 20:33

Door to Balloon Time 93 minutes

HA to Balloon Time 63 minutes

EMS Contact to Arrival CCL 130 minutes

Cardiac Catheterization/PCI

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Bottom Line…………………the old mantra rings true!

System saves time!System saves time!System saves muscle!System saves muscle!Systems saves lives!Systems saves lives!

System saves time!System saves time!System saves muscle!System saves muscle!Systems saves lives!Systems saves lives!

42

Treatment Delayed is Treatment Treatment Delayed is Treatment DeniedDenied

Antman EM et al. Circulation, 2004Antman EM et al. Circulation, 2004

Symptom Recognition

Call to Medical System

EDPreHospital

Delay in Initiation of Reperfusion Therapy

Increasing Loss of Myocytes

Cath Lab