Swift care saves heart patient

http://news.bbc.co.uk/go/rss/-/1/hi/health/7833910.stm

Version 0 of 1.

By Matthew Hill BBC News health correspondent Advertisement

Doctors treat John Truckle, aged 36, within hours of the onset of a heart attack

It was a normal newsroom morning when I took the call from Dr Peter Wilde to get to his cath labs at the Bristol Royal Infirmary straight away.

"We have a 36-year-old man with a suspected heart attack coming in by ambulance and he should arrive in 20 minutes," the medical director told me.

I managed to arrive in the corridor with my small camera just before John Truckle, from Clevedon, was wheeled down into a waiting bay.

Mr Truckle kindly allowed my unique access to film the primary angioplasty that was to save his life.

The procedure is used to unblock an artery carrying blood to the heart under a local anaesthetic.

It was John's wife, Claire, who called for the ambulance after the father of two complained of sharp stabbing pains in his chest and feeling clammy.

The irony is that John was himself due to be working in a hospital setting today, as a lighting engineer on the BBC Casualty set.

Like other cardiac attack patients, doctors had to get Mr Truckle on the operating table within two hours of the alarm being raised.

In the operating theatre some dye was injected into John's heart to locate the blockage.

Even for my untrained eye, it was easy to see where the blood flow has come to a complete stop on the CT scan screen.

Safer option

Until now the preferred treatment for heart attacks was to give injections of clot-busting drugs. But in up to half of patients the drugs do not work.

Professor Boyle is concerned about access in some areasSo for patients like John, primary angioplasty is the safer option.

A wire was inserted into John's wrist to take it up through a blood vessel into his heart to physically pull the clot out.

John was awake throughout the procedure, as he was under local anaesthetic.

It was just as well, because for one nerve-tingling moment his heart went into cardiac arrhythmia as the blood clot was cleared form his artery.

Dr Wilde told him to cough to kick start the organ into normal function.

Forty minutes after John came in, and the procedure was finished.

Big expansion

The Department of Health want 97% of heart attack patients to be offered primary angioplasty by October 2011.

The government's heart Czar is in talks with air ambulance services to try to ensure all heart attack patients in England have access to the new operation.

At present, it is only available to a quarter of patients - but the government wants it to be an option for everyone within three years.

Research has shown that heart attack patients have a 5.6% risk of death within the next 30 days if they receive primary angioplasty quickly.

For those treated with clot busting drugs, there is a 7.9% risk.

This equates to around 240 lives which could be saved in England every year - and 260 strokes.

To try to make this aim a reality, cardiac centres around the country are trying to agree a new model of care to fit the plan devised by Professor Roger Boyle, the government's national clinical director for heart disease and strokes.

The Bristol Heart Institute is one of several centres across England reaching agreements with neighbouring cardiologists to work an overnight shift at the centre, so that this new operation can be offered 24 hours a day.

Speed vital

Because it needs to be done very quickly, specialists have to be able to operate at a moment's notice and the patient has to be whisked straight to them by the ambulance.

But Professor Boyle said there were some rural areas, such as the Lincolnshire coast, Cumbria, Shropshire, Herefordshire and Cornwall and North Devon where it will be difficult to have a similar 24/7 model.

He believes the ultimate solution for those areas is air ambulances.

Professor Boyle said: "The problem with air ambulance is that most don't fly at night and there are also concerns about the cost.

"Ultimately that is the solution, but there is quite a lot of work to do before we can get the building blocks in place.

"We are working with ambulance services. The costs for air ambulance are quite considerable as they won't have more journeys to do, but longer journeys."