Local specialists in cardiovascular care, emergency medicine and emergency medical services have methodically reduced the time needed to diagnose serious heart attacks and restore blood flow to the heart, an advancement that earned Santa Rosa Memorial Hospital a #1 ranking out of 949 U.S. hospitals tracked for “door-to-balloon time” by the American College of Cardiology Foundation’s National Cardiovascular Data Registry.

Door-to-balloon time is the critical interval between a heart attack patient’s arrival at the hospital and the restoration of blood flow to the heart muscle in the Cardiac Catheterization Lab.

Recent improvements initiated by Coastal Valleys Emergency Medical Services and Santa Rosa Memorial Hospital have resulted in door-to-balloon times that consistently beat the national standard
of care, which equals 90 minutes or less.*

 “When clogged arteries are blocking the flow of oxygen-rich blood to the heart, every minute counts,” said Trish Scalercio, RN, Cath Lab Manager at Memorial Hospital. “The quicker we restore blood flow to the heart, the greater the patient’s chances of survival, full recovery and minimized heart muscle damage.”

During the first three months of 2009, the hospital’s door-to-balloon time averaged 66 minutes, hospital records show. Heart attack patients suffering an acute myocardial infarction, known as a STEMI, benefited from door-to-balloon times under 90 minutes in 100% of all cases handled at Santa Rosa Memorial between January and March.
This places Memorial’s door-to-balloon time as the highest-ranking out of 949 U.S. hospitals that participate in the American College of Cardiology Foundation's National Cardiovascular Data Registry, according to the most recently released report issued this summer. The quarterly report tracked patient outcomes for January through March.

Patients and their loved ones have benefited from coinciding initiatives by Coastal Valleys EMS and Santa Rosa Memorial, both concentrated on speeding detection of major heart attacks in the field so a multidisciplinary team at the hospital is on alert, standing by to rapidly administer medications, tests and life-saving interventions when the ambulance arrives.

When Coastal Valleys began piloting an early STEMI detection program in 2006 with local hospitals, “we set a loftier goal than 90 minutes’ door-to-balloon time,” said Bryan Cleaver, Regional EMS Administrator of Coastal Valleys EMS, an agency serving Sonoma, Napa and Mendocino counties. “We wanted a 90-minute limit between detection of STEMIs by paramedics treating patients at their homes or in the community and any Cath Lab intervention. For us, it’s home-to-balloon time.”

Historically, confirmation that patients were suffering a STEMI often was not made until after a patient’s arrival at the Emergency Department. But thanks to a widespread upgrade in cardiac monitoring – with most local paramedics now using a 12-lead electrocardiogram to evaluate patients after a 911 call – notification to hospitals to activate their STEMI team is occurring faster, well before a patient reaches the Emergency Department.

“When the patient arrives, all the people who need to care for that patient are waiting at the bedside and the Cath Lab is ready to go,” said Denise Thomas, RN, Emergency/Critical Care Services Clinical Nurse Specialist in Memorial’s Emergency Department.
The opening in November 2008 of Memorial’s new Heart & Vascular Institute, positioned immediately adjacent to the Emergency Department, helped Memorial’s clinical staff shave 2 to 5 minutes off typical treatment times for heart attack patients. But it was the coordinated effort of cardiologists, emergency physicians and nurses – who each month studied previous patients’ charts to search out opportunities to expedite care – that made the more crucial impact.
Emergency Department doctors and nurses worked closely with lab, X-ray and respiratory care professionals to reduce pre-Cath Lab prep time to as few as 13 minutes in some cases, Thomas said. Thanks to streamlined triaging by paramedics and the Emergency team, Cath Lab experts also were better equipped to cut wait times for high-risk patients in need of balloon angioplasty, stenting and other emergency procedures.

Cabinet maker Carl Mannle, 66, is among patients whose rapid door-to-balloon time – 38 minutes after he suffered a heart attack at his home in Sonoma in November – enabled him to recover without long-term damage to his heart muscle.

Mannle had been reading the newspaper on his home computer at 8 a.m. that autumn morning when suddenly he felt “unbelievably ill, like the worse case of flu your body ever felt,” he remembered. “I got up to walk down the hall and it just hit, bang.”

Within minutes of his daughter’s 911 call, paramedics arrived, gave Mannle a chewable aspirin and confirmed with the 12-lead electrocardiogram (ECG or EKG) that he was suffering an acute myocardial infarction. The 25-minute drive by ambulance brought him to Memorial’s Emergency Department, then on directly to the Cath Lab, where he underwent angioplasty and stenting.

“The paramedics were in radio contact with the hospital and everything was all set up and ready when they got me there,” Mannle said. “I got excellent care. The success of my treatment to a very great extent had to do with the expediency of the treatment. Everything proceeded with no delays.”