When someone is suffering a heart attack, time is muscle as precious heart tissue dies of oxygen deprivation. The sooner blood flow can be restored to the starving muscle cells, the less damage is done.
Salt Lake City paramedics and LDS Hospital are participating in a study with an extremely fast-acting anti-coagulant drug to try to cut those minutes down, said Mike Jessop, Salt Lake Emergency Services medical division coordinator."The quicker you get the drug on board, the more (heart) muscle survives, he said. "The study's purpose is to determine if it is feasible for paramedics to administer the drug in the field."
The drug is called Activase, and it is a "tissue plasminogen activator." It begins to dissolve blood clots as soon as it is given, and is completely metabolized in about 20 minutes, said Jessop. The drug's speed in clearing clogged blood vessels might be used more effectively by administering it as soon as possible rather than waiting until the patient is at the hospital.
The study is being sponsored by the makers of the drug. Genetech, a San Franciso-based company, has donated the use of six 12-lead portable electrocardiograms and enough Activase to conduct the study.
Activase is FDA-approved and, at $2,200 per dose, very expensive. Patients who receive the drug through a hospital or physician pay for it, but Jessop emphasizes anyone who receives it as part of the study will not be charged.
Paramedics responding to calls where the person complains of chest pains will question the patient about his medical history and other criteria and contact the hospital on a cellular phone. An emergency room physician will approve the ECG test.
The paramedic will hook up the ECG and begin transmitting the information to LDS Hospital. The 12-lead ECG has 10 electrodes and can send 12 different "pictures" of the heart's electrical impulses to physicians at LDS Hospital.
Patients with a history of stroke, seizures, brain surgery, aneurysm or hemophilia cannot take Activase because its one side effect is bleeding, said Jessop. Other eliminating conditions include having had surgery or a trauma injury in the last two months, pregnancy, and bleeding ulcers.
If all the factors line up, the doctor will prescribe Activase over the phone. The patient must be conscious and oriented, because paramedics need his consent to administer the drug. A 20 milligram dose will be given at the scene, followed by a 80 milligram dose on arrival at LDS Hospital.
The study will include 100 patients with the same heart problems, history, age group and blood pressure. Fifty of the patients will be given the drug and 50 will not, but all 100 will be monitored through their recovery or death.
The quick use of Activase could have a dramatic effect on the survival rate of heart attack victims, said Jessop. Heart failure causes about 600,000 deaths per year, and 90 percent of them are caused by blockages in the heart.
"My personal guess is that in three to five years the most sophisticated paramedic units will be using it," he said.