DOOR-TO-BALLOON

TIME
Justin, Katie, Brittney, Corrie, Andrea
Door-To-Balloon Time
The interval from when the person first arrives at the
emergency department until balloon inflation in a
catheterization lab.

American Heart Association recommended D2B time is
less than 90 minutes.
Importance
Decreasing the D2B time decreases the amount of
cardiac cell necrosis.

Most people do not come right when their symptoms start.

Reducing time for patients with a STEMI can improve
long term survival and decrease rate of complications.
Almost 500,000 Americans experience a STEMI each
year.

Of those who receive cardiac catheterization only 40%
are treated with the door to balloon time frame of 90
minutes.

32% of all MI are STEMI.
What is a STEMI?
ST elevated myocardial infarction.

A serious type of MI in which one coronary artery is
completely occluded.

The are 4 types of coronary arteries that can be blocked.
STEMI
A STEMI is diagnosed by an elevation of a ST segment
on an ECG.

Treatment:
Requires immediate attention because the artery is completely
occluded.
Angioplasty


NSTEMI
Non-ST segment elevation myocardial infarction.

Less severe than a STEMI.

Treatment: Balancing the supply and the demand of
oxygen to prevent further ischemia.
Not as urgent as a STEMI.
preventing ischemia instead of fixing the infarction.
MONA
Possible angioplasty
Thrombolytics
ECG
Electrocardiogram

Reads the electrical activity of the heart.
Review of the Heart
ECG
http://www.youtube.com/watch?v=v3b-YhZmQu8
Normal ECG
STEMI ECG
What ECG shows a STEMI?
A. B.
C. D.
Answer: B.
Treatment for STEMI: Angioplasty
Opens blocked arteries and restores blood flow in the
heart.

A catheter is thread through a small puncture in the leg or
arm artery to the heart.

Then the blocked artery is opened by the inflation of a
balloon.

Angioplasty: Procedure
A catheter is inserted into an artery in the groin or arm.
The catheter is threaded through the arties until it gets to
the coronary artery.
An X-ray is used to help the doctors move the catheter
into the occluded artery.
A thin wire is threaded through the catheter and across
the blockage.
Another catheter with a balloon on the end is put on the
wire and passed through the blockage.
The balloon is inflated and it pushes the plaque to the
side and opens the artery.
Angioplasty: Procedure
Sometimes a sent is mounted on a special balloon and
moved on the wire to the blocked area.
When the balloon is inflated it opens the stent against the
artery walls.
The sent helps keeps the artery open.
The catheter is then removed from the leg or the arm.


Angioplasty
Angioplasty
Video
Ways to Decrease Door-to-Balloon Time

Create STEMI protocols or standing orders in the ED.

Allow EMS to diagnose a STEMI on the pre-hospital ECG
and transport patient directly to cath. lab (bypassing
the emergency department).
Create STEMI protocols or standing
orders in the ED

Create an on-call STEMI team.
Train staff appropriately.
Ability to active cath lab 24/7.
If a person arrives with MI symptoms an ECG must be ran
within 10 minutes.
1 phone call can page the entire STEMI team.
The STEMI team has 30 minutes to arrive at the hospital.
Create a quality improvement team to review all case with
a D2B over 90 minutes.
Using 12-lead EGCs in the EMS to
diagnose a STEMI

12-lead ECG

A lead is a view of the electrical activity of the heart from a
particular angle across the body.

10 electrodes, but captures 12 different electrical signals.

Diagnosing a STEMI requires a 12-lead ECG.


Using 12-lead EGCs in the EMS to
diagnose a STEMI
Using 12-lead EGCs in the EMS to
diagnose a STEMI

The paramedics can perform the ECG on the field and
diagnose the patient with a STEMI.

The paramedics can transmit the ECG to the hospital.

Benefits:
Will not have to diagnoses once in hospital.
Hospital can get ready for the patient.
Decrease time until treatment.
Paramedics can activate cath. lab and bypass the ED.
Post-Test
1) What are two ways to decrease door-to-balloon time?
A) ECGs in the EMS to diagnose a STEMI and create a
STEMI protocol.
B) ECG within 20 minutes of arrival and create a STEMI
protocol.
C) Drive yourself to the hospital three days after
symptoms and eat a banana.

2) Define what a STEMI is:
A) A MI because of a partial occlusion of the coronary
artery.
B) A total occlusion of coronary arteries resulting in a ST
elevation.
C) A partial occlusion of the coronary arteries resulting in
a ST depression.

Post-Test
3) What is the recommended door to balloon time?
A) 65mins
B) 90mins
C) 3hrs
D) 190mins

4) Choose the correct sequence of EKG points of reference.
A) P, U, R, Q
B) T, R, S, P, Q
C) A, P, E, T, M
D) P, Q, R, S, T

Post-Test
5) What is the purpose of an angioplasty?
A) Arties from other parts of the body are grafted to
the coronary arteries to bypass blocked arteries and
improve blood flow.
B) To permanently insert a balloon into the blocked artery
to increase blood flow.
C) Opens blocked arteries and restores blood flow to
the heart by inflation of a balloon.

References
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Barbagelata, A. (2010). From theory to practice: Implementation of pre-
hospital electrocardiogram transmission in ST-segment elevation
myocardial infarction - a multicenter experience. Journal of Invasive
Cardiology. (22)11. 520-525.

American Heart Association. (n.d.) Retrieved March 21, 2013 from
http://www.heart.org/
HEARTORG/HealthcareResearch/MissionLifelineHomePage/LearnAboutM
issionLifeline/STEMI-Systems-of-Care_UCM_439065_SubHomePage.jsp

Bajaj, S., Parikh, R., Gupta, N., Aldehneh, A., Rosenberg, M., Hamdan, A., &
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