CHICAGO — Implementing a novel hospital-wide trauma approach to ST-elevation MI has enabled one major medical center to slash its door-to-reperfusion times and far surpass national standards.
The “Code STEMI” protocol was initiated at Carolinas Medical Center to streamline identification, transport, and treatment of patients with STEMI. Since its implementation, the average time from arrival in the emergency department to reperfusion has dropped to 63 minutes, Kevin M. Collier, RCIA, reported at the annual meeting of the Society for Cardiovascular Angiography and Interventions.
American College of Cardiology/American Heart Association guidelines call for a door-to-reperfusion time of 90 minutes or less. However, a 2004 report from the National Registry of Myocardial Infarction concluded that only 43% of U.S. hospitals were meeting that standard.
Carolinas Medical Center is an 861-bed urban teaching hospital in Charlotte, N.C. It serves as the major referral center for a multistate 29-county area. About 105,000 patients pass through its ED annually.
The Code STEMI protocol utilizes a trauma approach, meaning hospital staff are notified by paramedics that a STEMI patient is en route so the STEMI team is fully prepared for the arrival.
For Code STEMI, paramedics were trained to acquire and read a 12-lead ECG in patients with suspected MI and transmit the results from the field to an emergency physician at the hospital. If the physician determines the patient has a STEMI, the Code STEMI is activated. This triggers simultaneous pages to all members of the Code STEMI team: the cardiologist on call, the coronary care unit, the cardiac cath lab, the radiology and respiratory medicine departments, the hospital lab, and bed management. Upon arrival at the ED, the patient undergoes expedited triage to confirm the STEMI, then goes straight to the cath lab for primary percutaneous coronary intervention (PCI), said Mr. Collier.
He presented a retrospective study involving 114 consecutive STEMI patients treated at the hospital since Code STEMI was launched in October 2004 and a control group of 62 STEMI patients treated by primary PCI in the prior 9 months.
The mean door-to-reperfusion time for patients transported by paramedics dropped from 72 minutes to 54 minutes with Code STEMI. For patients not transported by paramedics, door-to-reperfusion time fell from 116 to 74 minutes.