Time is Muscle For Carroll Hospital Center’s Cardiac Care Unit

Written By Lisa Breslin

Members of the Cardiac Care and Catheterization Lab at Carroll Hospital Center are familiar with an important adage: Time is muscle.

Its significance: The more minutes that tick away between the onset of a heart attack, the more heart muscle destroyed.

Since October, a team of doctors, nurses, emergency technicians and hospital personnel has saved not only time and muscle, but also 25 hearts, thanks to a new partnership with the University of Maryland Heart Center.

The partnership with UMD’s Heart Center brings together interventional cardiologists Dr. Mark Vesely, Dr. Peter Reyes, Dr. David Zimrin and Dr. Anuj Gupta and a life-saving treatment called percutaneous coronary intervention (PCI), better known as emergency angioplasty, at Carroll Hospital Center.

The initiative was launched by need, according to hospital officials.

“We were transferring patients to Baltimore and it took several hours,” said Sharon Sanders, director of cardiopulmonary services and outpatient services who has worked at the hospital for 21 years. “We knew we could do this here.”

According to hospital statistics, 110 patients were transferred to Baltimore area hospitals for emergency angioplasties in 2006, and 103 in 2007.

“The need isn’t always in the numbers; time is just as, if not more, important,” said Sander.

By offering the technique at Carroll Hospital Center, the emergency procedure can in most cases be completed within 90 minutes from the time the patient arrives at the hospital.

“When a heart attack begins, the stopwatch begins,” said Dr. Zimrin. “The longer it takes to open the artery, the greater the potential heart damage.”

Physicians perform the procedure by threading a small tube with a tiny balloon at the end through a large blood vessel in the groin. Once the tube reaches the blockage in the heart, the balloon is inflated, pushing the artery open and restoring blood flow. A stent, a small, expandable mesh tube, is often placed in the newly widened artery to hold the vessel open.

“They told me when they were accessing the vessel that I might feel a little pressure, but all I remember is the pain melting away. I could actually feel it leaving,” said Patient Number 7, a nurse in Carroll County who requested anonymity. “I remember opening my eyes, seeing the nurses and thinking ÔHey, I’m back.’”

“Our goal is to restore blood flow within 90 minutes of the patient’s arrival.” said Dr. Zimrin.

But Patient Number 7, and many of the others who have been through the procedure, have blood flow restored in less time.

Shaving minutes from the process takes a team: from emergency personnel who respond to the initial call, the admitting staff and prep nurses, to the staff member who holds the elevator door open when a PCI patient is rolled in.

“This has been the biggest display of teamwork I have seen anywhere,” said Sanders. “Everyone has been engaged, from housekeeping to the physicians; everyone knows their roles. If they don’t have a role, they often ask what role they can play.”

Hospital employees are so excited about the positive results, it’s not uncommon to hear someone in Admitting to say “Yes!” when a “STEMI” alert” is called.

“STEMI” stands for ST Elevation MI, which is the type of heart attack that can be treated with emergency angioplasty. Because every ambulance and life support unit in the county has been equipped with the technology and trained emergency personnel to assess a patient’s status and alert the hospital, the stopwatch can begin.

Shaving minutes took practice. Months before the first patient was transported to the hospital for an emergency angioplasty, teams ran drills complete with stand-in patients who were hospital administrators’ family and friends.

At the heart of the timed routine is a red packet, complete with heart shaped stickers, that includes all the paperwork needed to admit the patient and expedite the preparations for surgery.

“I could not have written a better script,” said Patient Number 7. “The nurses were so nice, I sent them a fruit basket afterwards. The emergency angioplasty procedure is a well-oiled machine at Carroll Hospital Center. I’m just so thankful.”

The well-oiled machine is yielding impressive statistics.

The American Heart Association and the American College of Cardiology suggest that the procedure should be completed in 90 minutes or less. Carroll’s team is averaging 68 minutes.

“My goal is to save 100 hearts this year,” said Sanders.

The hospital has invested more than $1.5 million to put the emergency angioplasty program in operation, and it anticipates spending $1.5 million more to complete additional renovations, according to Sanders.

To date, the Toshiba Cardiovascular Lab bore the biggest price tag ($1.2 million).

The hospital plans to add other advanced cardiology services and procedures, including electrophysiology and treatments for advanced heart failure, including post-transplant care.