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Cardiac care

Lab tests to be performed in Edmontons ambulances

EDMONTON – A new research project will soon put medical lab equipment into local ambulances, allowing patients with acute heart problems to receive faster diagnosis and treatment. The PROACT (Providing Rapid Out-of-Hospital Acute Cardiovascular Treatment) project is looking at new ways to treat patients with heart attack and heart failure before they arrive at the emergency department (ED).

“The mobile laboratory will allow us, with a drop of blood, to measure whether heart damage has occurred and whether the likelihood of heart failure is high,” says cardiologist Dr. Paul Armstrong (pictured), team leader and a professor at the University of Alberta. “We’re going to see whether bringing the laboratory outside the hospital to the ambulance can expedite the care and lead to a better outcome. We think that’s pretty special.”

Dr. Armstrong says every second counts when dealing with a cardiac episode.

“The longer one waits to be cared for, the more muscle damage that’s likely to occur and the greater the threat to life and the future quality of life,” he says. “Time is muscle and muscle is life.”

Expanding the role of emergency medical services technicians and paramedics to treat patients on-site is among the goals outlined in the 5-Year Health Action Plan, jointly developed by the Government of Alberta and AHS, and supported by the province’s stable, 5-year funding.

“EMS saves lives every day and, with this research study, we have an opportunity to provide further assessment and treatment for cardiac patients on the scene or as we’re travelling to hospital,” says Emerson North, a paramedic and clinical educator with AHS EMS. “We think saving this time will save lives and I’m excited that EMS in Edmonton will play a significant role in a research study that could set a new standard for cardiac care.”

A multidisciplinary team of experts from the Mazankowski Alberta Heart Institute are leading the project, which involves collaboration between cardiologists, ED physicians, paramedics and all Edmonton-area hospitals. The project is supported by a $225,000 grant from the University Hospital Foundation.

“The University Hospital Foundation is committed to advancing leading-edge cardiac research,” says Foundation President Joyce Mallman Law. “We are passionate about supporting extraordinary people like Dr. Armstrong and his team, who are doing extraordinary things that change and save lives.”

The project builds on the successes of the Vital Heart Protocol – developed here a decade ago by a team including cardiologist Dr. Robert Welsh – which transformed care for heart attack patients. It led to today’s better-trained paramedics, on-ambulance ECGs (electrocardiograms) sent to doctors via cellphone technology to confirm diagnosis, and paramedics equipped with the latest medications including clot-busting drugs to begin life-saving treatment immediately.

The Vital Heart Protocol has proven particularly effective for patients who experience a STEMI (ST Elevation Myocardial Infarction) heart attack and require rapid assessment and treatment to minimize heart damage. A STEMI heart attack occurs when a blood clot completely blocks the coronary artery, causing the heart muscle supplied by that artery to die.

PROACT will study how to give the earliest-possible intervention to two more groups of patients – those with non-STEMI heart attacks and acute heart failure – right in the ambulance.

“With PROACT, we began to think more broadly: Could we take this business of providing more rapid, out-of-hospital care for other forms of cardiovascular disease?” says Armstrong, who credits leadership provided by heart-failure expert Dr. Justin Ezekowitz.

Heart failure is the inability of the heart to provide sufficient blood flow to meet the body’s needs.

A non-STEMI heart attack is caused by a partially blocked blood supply to a portion of the heart. These heart attacks are more common than STEMIs and are difficult to diagnose. Patients may not even realize they’re having a heart attack, often resulting in treatment delays.

“Non-STEMIs are actually a more common cause of death,” says Armstrong.

During the two-and-a-half year study, paramedics will offer in-ambulance blood testing and clot-busting treatment, when medically directed, to 1,000 to 1,500 patients – then compare outcomes with those of patients who waited until arrival at hospital for blood tests and treatment. If the PROACT research delivers the expected results, it could lead to a new standard of early intervention and care across Canada and beyond.

“With the Vital Heart Protocol, we were able to shave off about an hour of time in terms of shortening the time to treatment,” says Dr. Welsh. “Now, with PROACT, we want to move the whole process of diagnosis and treatment out of the hospital to the patient to deliver life-saving therapy earlier and closer to the coalface of these problems.”

The University Hospital Foundation raises funds to support innovation and excellence at Edmonton’s University of Alberta Hospital and Mazankowski Alberta Heart Institute.

Alberta Health Services is the provincial health authority responsible for planning and delivering health supports and services for more than 3.7 million adults and children living in Alberta. Its mission is to provide a patient-focused, quality health system that is accessible and sustainable for all Albertans.

Posted October 6, 2011