Text: Denis Orsat

Bringing the right response, and fast

In less than two years, more than 500 patients have been treated using the new myocardial infarction care process set up jointly by the Cardiology Service, Emergency Service and Adult Intensive Care Service at Lausanne University Hospital (CHUV).

When it comes to acute myocardial infarction, time is muscle! In just 30 minutes, coronary artery occlusion due to a blood clot can cause necrosis of cardiac tissue. Myocardial damage and the risk of death increase with each passing second.

The Cardiology Service (Department of Medicine) understands this and wanted to do something about it by reducing the time it takes for patients to get treatment both inside and outside the hospital. That’s how the STEMI care process was created.
Mobilising a multi-disciplinary team that includes the Emergency Service, Adult Intensive Care Service and the Department of Public Health of Vaud (Département de la santé publique du canton de Vaud), the STEMI care process was launched at the CHUV in January 2013. Since then, fast and effective care has been administered to more than 500 patients from all over the canton.

How does it work?
If the paramedics receive a call at Switzerland’s 144 emergency number with reports of chest pain, the Mobile Emergency and Reanimation Service (SMUR) doctor immediately performs an electrocardiogram (ECG) once arriving on site. The ECG tracings are sent by telemetry to the CHUV Emergency Service. If the ECG meets the predefined criteria, the STEMI care process is activated. No matter where the patient is in Vaud, he or she is taken directly to the CHUV – the only hospital in the canton that practises primary angioplasty in the event of a heart attack, 24 hours a day, 7 days a week. Within minutes after arrival, the patient is on the cardiac catheterisation table, where everything is ready for the angioplasty to open the occluded coronary artery (catheterisation room pictured). This drastically reduces care time. Less damage is caused, and lives are saved.

What impact has the procedure had?
Since the STEMI procedure was put in place at the CHUV on 7 January 2013, significant progress has been made in treating patients diagnosed with acute myocardial infarction and treated following the CHUV’s STEMI care process:

-Median “door-to-balloon” time reduced by 25 minutes, from 71 to 46 minutes;

-Median “first medical contact-to-device” time shortened from 125 to 88 minutes.

-Total median coronary occlusion time (or total myocardial ischemia time, meaning the time from symptom onset to balloon inflation) down from 219 to 188 minutes.

What next?

The CHUV’s STEMI care process and its results were presented at the annual European Society of Cardiology Congress held in Barcelona at the end of August 2014. Its efficiency sparked immense interest and could inspire other centres in Europe. At the cantonal level, the population’s awareness needs to be raised about this issue. As soon as the first sharp chest pains occur, the patient must immediately call the paramedics at 144, then wait calmly at home. If the diagnostic criteria of myocardial infarction are met, the STEMI care process will take care of the rest.