10:19am Friday 06 December 2019

Stopping Heart Attacks in the Middle of the Night

MAYWOOD, Ill. — Railroad conductor Michael Tyler was working the night shift when he was hit by a life-threatening heart attack.

It was after 1 a.m. when Tyler, 41, arrived at the emergency room of Loyola University Hospital, the only center in Illinois with an interventional cardiologist on site 24 hours a day, seven days a week.

Loyola’s Heart Attack Rapid Response Team (HARRT) stopped Tyler’s heart attack by reopening a coronary artery with an emergency balloon angioplasty. It took just 33 minutes.


“To get that done in the middle of the night in a half hour — Wow!,” Tyler said. Thanks to his rapid treatment, Tyler experienced virtually no lasting damage to his heart.

National guidelines say patients undergoing heart attacks should receive balloon angioplasties as soon as possible or within 90 minutes of arriving at the hospital — known as the “door-to-balloon time.”

In the first year since HARRT was launched, Loyola has far exceeded that standard, with a median door-to-balloon time of just 41 minutes. All patients have received balloon angioplasties within 90 minutes, and 88 percent within 60 minutes. The fastest procedure was done in just 22 minutes.

Most hospitals do not have teams on site during nights and weekends. Precious time is lost when interventional cardiologists, nurses and technicians have to be called from home — especially in bad weather. At Loyola, by contrast, an interventional cardiologist is on site at all times, along with nurses and technicians.


“Time is Muscle,” said Dr. Fred Leya, medical director of Loyola’s cardiac catheterization lab. “If we can reopen the artery within 30 minutes, there will be essentially no damage. If we do it within 30 to 60 minutes, there will be minimal damage. That’s why we call the first 60 minutes the Golden Hour of Opportunity.”

A 2009 study in the British Medical Journal documented how a rapid response can save lives. Researchers examined records of 43,801 patients at more than 600 hospitals in the United States. The in-hospital mortality rate was 7 percent among patients with 150-minute door-to-balloon times, 4.3 percent among those treated in 90 minutes and just 3 percent among those treated in 30 minutes.

“Physicians could reduce mortality among such patients by minimizing door-to-balloon times to the greatest extent possible,” researchers wrote.

Tyler’s case illustrates the benefits of a rapid response. Tyler, of Country Club Hills, Ill., was preparing to depart from the Union Pacific yard in Northlake, Ill. when his heart attack struck. After a few minutes of chest pain and shortness of breath, Tyler asked his engineer to call 911. As the ambulance rushed Tyler to Loyola, paramedics administered an EKG and radioed the results to Loyola. As soon as Tyler arrived at the ER, he was rushed to the cardiac catheterization lab.

Tyler’s left anterior descending artery, one of the major coronary arteries, was 100 percent blocked. Working quickly but carefully, an interventional cardiologist threaded a catheter (thin tube) from an artery in Tyler’s groin to his heart. The cardiologist inflated a balloon at the tip of the catheter to open the artery, and placed a stent (wire mesh tube) to keep the artery open.

Tyler’s heart attack was stopped as soon as the artery was opened. Because blood flow was quickly restored, there was very little damage to his heart muscle.

“It was a great example of how our rapid response team is preserving hearts and saving lives,” Leya said.

Based in the western suburbs of Chicago, Loyola University Health System is a quaternary care system with a 61-acre main medical center campus, the 36-acre Gottlieb Memorial Hospital campus and 25 primary and specialty care facilities in Cook, Will and DuPage counties. The medical center campus is conveniently located in Maywood, 13 miles west of the Chicago Loop and 8 miles east of Oak Brook, Ill. The heart of the medical center campus, Loyola University Hospital, is a 561-licensed-bed facility. It houses a Level 1 Trauma Center, a Burn Center and the Ronald McDonald® Children’s Hospital of Loyola University Medical Center. Also on campus are the Cardinal Bernardin Cancer Center, Loyola Outpatient Center, Center for Heart & Vascular Medicine and Loyola Oral Health Center as well as the LUC Stritch School of Medicine, the LUC Marcella Niehoff School of Nursing and the Loyola Center for Fitness. Loyola’s Gottlieb Memorial Hospital campus in Melrose Park includes the 264-bed community hospital, the Gottlieb Center for Fitness and the Marjorie G. Weinberg Cancer Care Center.

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