Time is muscle

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August 16, 2010
By: Gregory J. Scott
Gregory J. Scott
Faces of HCMC // The Cardiac Catheterization lab

Despite all the technical jargon and hospital-speak at his disposal, cardiologist Dr. Fouad Bachour sums up his job in just two pithy slogans: “Time is muscle” and “Dead meat don’t beat.”

As director of HCMC’s Cardiac Catheterization lab, Bachour’s goal is to get the blocked arteries of a heart attack victim open as soon as possible. Every minute matters when heart muscle is dying, and Bachour’s Cardiac Cath team is fast. HCMC’s door-to-balloon time — measured from the moment the ambulance arrives in the ER to the moment the patient’s blocked artery is forced open by an angioplasty balloon — is one of the lowest in the United States, beating the 90-minute gold standard by over half an hour.

“From studies, we know that the goal is less than 90 minutes,” said Bachour. “But we also know that 60 is better than 90 minutes. And 30 minutes is better than 60.”

In 2009, according to Bachour, the lab clocked in at an average time of 59 minutes. The lab’s shortest door-to-balloon time that year was 11 minutes, and every angioplasty procedure came in under the 90-minute mark. According to a 2006 study from the National Heart, Lung and Blood Institute, only 35 percent of hospitals in the nation report a door-to-balloon time of 90 minutes or less.

The impressive numbers are due to a 2004 initiative that trained paramedics to assess EKGs in the ambulance and activate the Cardiac Cath team during the ride to the hospital.

“Before, that travel time was wasted,” said Gina Jacobsen, a nurse who has worked in Bachour’s lab for five-and-a-half years. Now, the lab can prepare while the paramedics are en route. “While they’re coming into the hospital, we’re coming into the hospital,” Gina said. This is particularly useful during after-hours emergencies, when on-call lab staff need to race in to meet a patient.

But heart attack emergencies aren’t the only procedures that happen in the lab. Patients like Mike Dowd, who suffers from an irregular heartbeat, come in regularly for cardio-conversions. A quick, 100-Joule jolt to the chest, administered through a pair of stickers, gets the heartbeat back into a healthy rhythm. The whole process takes only three to five minutes, during which the patient is asleep.

“I’ve woken up sometimes afterward and had the staff laugh at how high I jumped,” Dowd said.

The other common procedure in the Cardiac Cath lab is the angiogram. A catheter is inserted near the groin, and a doctor snakes it up through the aorta in order to flood the heart’s arteries with a radiological dye. The coursing dye can be viewed with an X-ray.

“And that’s how we see if there are any blockages we need to fix,” said Jacobsen. “It’s pretty cool to watch.”