STEMI/STROKE BOOT
CAMP
“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.
Slide reproduced with permission from Cannon CP: Atherothrombosis slide compendium; www.theheart.org
Treatment Delayed is Treatment
Denied
Symptom
Recognition
Call to
Medical System
PreHospital
ED
Cath Lab
Increasing Loss of Myocytes
Delay in Initiation of Reperfusion Therapy
Antman EM et al. Circulation, 2004
11
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 # 1
Dispatched
Arrived at Scene
Arrived at Patient
Field EKG
Transport
Heart Alert Called (“ETA 10 min”)
Arrived at CCL (direct admit)
Balloon Time
Door to Balloon Time
EMS Contact to Balloon Time
7:52
7:56
7:57
8:04
8:07
8:23
8:35
9:01
26 minutes
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
Launch Request
Lift off
Arrive at Scene
17:20
17:55
17:59
18:23
Transport
Arrive CRMH
Arrived at ED
18:34
18:50
19:00
Heart Alert called
Balloon Time
Door to Balloon Time
19:30
20:33
93 minutes
HA to Balloon Time
EMS Contact to Arrival CCL
63 minutes
130 minutes
Cardiac Catheterization/PCI
Bottom Line…………………
the old mantra rings true!
System saves time!
System saves muscle!
Systems saves lives!
41
Treatment Delayed is Treatment
Denied
Symptom
Recognition
Call to
Medical System
PreHospital
ED
Cath Lab
Increasing Loss of Myocytes
Delay in Initiation of Reperfusion Therapy
Antman EM et al. Circulation, 2004
42