Mobile EKG speeds heart attack response

EKGs to be sent ahead to hospital
Tom Cauley and his wife, Dot, sit at University Hospital Heart and Vascular Institute. An experienced paramedic saw his EKG in the ambulance and called ahead with details to University Hospital.



It was a fortuitous safety meeting that morning that kept Tom Cauley on the ground and not high up in the MOX plant under construction at Savannah River Site.

He felt hot during the Jan. 12 meeting and went outside, where he really began to feel bad.

"It felt like somebody parked a truck on my chest," he said.

Cauley, 54, of Sylvania, Ga., was having a certain kind of heart attack, called an ST-segment elevation myocardial infarction, or STEMI, that often results from a blockage in a coronary artery. He was fortunate an experienced paramedic saw his EKG in the ambulance and called ahead to University Hospital.

University and Gold Cross EMS now have a system that makes sure what happened in Cauley's case happens for every suspected heart attack patient. Called LIFENET, the system allows ambulances to transmit wirelessly an EKG of a suspected heart attack to a software system at University, where it can be seen in real time, said Maj. Michael Willis, the clinical services manager for Gold Cross EMS. With a touch of a button, all appropriate personnel can be notified and activated to respond, he said.

"It brings the team closer together, and it activates the appropriate members of that team quicker when they see this EKG in real time," Willis said.

It is part of University's push to lower what is referred to as the door-to-balloon time, or the time between when a patient enters and the start of a cardiac catheterization. While the standard is 90 minutes or less, University's median time in the third quarter of 2009 was 63 minutes, a reduction of 20 minutes just last year, said Teresa Waters, the director of cardiovascular services.

The reductions in time make a big difference for patients. A 2007 study in the journal Circulation found reducing door-to-balloon time from 114 to 76 minutes resulted in 40 percent less damage to the heart, Waters said. Cost and the length of the patient's hospital stay also decreased, she said.

And there is evidence the ambulance system can help. A study published recently in the journal Catheterization and Cardiovascular Interventions found wirelessly transmitting EKGs from the field to the hospital dropped door-to-balloon times from 90.5 to 60.2 minutes. That 30-minute window can translate into 7.5 percent less risk of mortality in one year, the journal noted.

It is a hurry-up message physicians have been preaching for years.

"Time is muscle," said Dr. Paul Cundey III, Cauley's cardiologist. "The quicker you get there, the more lives you can save; the less the mortality, the better the outcome."

In Cauley's case, his arteries were being opened within 40 minutes, Cundey said.

And the outcome is night and day, Cauley said.

"After he worked on me, I feel like I'm 25 years old again," he said. "I feel real good."

Heart attack symptoms

Physicians and emergency medical personnel stress the importance of recognizing the symptoms of a heart attack and promptly seeking care or calling 911. While some symptoms will attack suddenly, many heart attacks develop slowly, the American Heart Association said.


- Shortness of breath

- Pain in the center of the chest that lasts several minutes, or goes away and comes back; it can also feel like a painful fullness, squeezing or pressure

- Nausea, cold sweat or a light-headed feeling

Women are more likely to experience shortness of breath, pain in the back or the jaw, and nausea, the heart association said.

Source: American Heart Association