On Thursday, May 28th, Hunterdon Medical Center’s Mobile Intensive Care Unit became the first in the nation to add a P2Y12 inhibitor (a classification of medications for anti-platelet inhibitors) , an anti-platelet drug to their medication boxes on all their mobile units. For patients who are experiencing an ST-Elevation Myocardial Infarction (STEMI), the most deadly type of cardiovascular event worldwide, the addition of these agents allows treatment at the point of contact and drug effect early in the course of the heart attack.
Based on available scientific evidence and guidelines HMC MICU chose BRILINTA (ticagrelor) as its P2Y12 inhibitor of choice as it has been proven to be safe in this setting and extends the reach of our ED into the field at the point of first patient contact.
“Early treatment of a completely blocked artery minimizes the extent of the heart muscle damage and preserves the pumping function of the heart which can help increase survival. Once administered, Brilinta takes about 20 minutes to begin to work. By receiving this medication in the field, as early as possible, the rapid ingestion through the GI tract and direct bio-availability to the clot, stands to result in a significantly softer clot,” explained Martin Hogan, Director of Hunterdon Medical Center’s Mobile Intensive Care Unit. Once the patient arrives to the Emergency Department and eventually the catheterization lab, the Interventional Cardiologist can perform emergency angioplasty, which results in a mechanical disruption of the obstruction and thereby allowing delivery and deployment of a stent to maintain the flow through the artery.
“Many of these STEMI patients would have died in the past decades, as treatment consisted of nothing more than analgesics, bed rest and observation. Our contemporary approach that includes a multi-disciplinary team, the Mobile Intensive Care Unit is contributing significantly to the process through the early interventions of STEMI recognition, IV’s, MONA and now “Brilinta”. Now, most of the same type of patients are not only surviving a cardiac event which could have ended their lives, but are surviving in most cases with almost no lasting heart muscle damage and are having full lives with their families, stated Mr. Hogan.
Hunterdon Medical Center’s Mobile Intensive Care Unit worked on a collaborative initiative to add P2Y12 inhibitors to their medication formulary which is approved by the Department of Health. Andrey Espinoza, M.D., Interventional Cardiologist at Hunterdon Medical Center and Mike Prendergast, M.D., Medical Director for Hunterdon Medical Center’s Mobile Intensive Care Unit, presented at a New Jersey Department of Health Mobile Intensive Care Unit Medical Advisory Council (MAC) on the importance of administering P2Y12 inhibitors in the field as opposed to waiting until the patient arrives to the Emergency Department. “The American College of Cardiology Guidelines are clear on this issue. They state that these drugs that are the mainstay of therapy for STEMI patients and should be administered as early as possible after diagnosis. For us, at HMC, that is at the point of first contact with the patient encountered by the MICU. Why wait 20 or 30 minutes for the patient to arrive in the ED to give the same exact medications? The patient is having the heart attack now, not at some remote time point in the future. Though this effort may seem revolutionary, this practice has been commonplace in Europe and other parts of the world for many years. We are finally catching up.” Dr. Espinoza.
The MAC committee endorsed that anti-platelet medications be added to their the optional formulary and the NJ Department of Health approved and granted this be added to all Mobile Units, throughout NJ.
“This is a significant achievement. Not only has Hunterdon Medical Center lead the way in gaining the approval for all Mobile Intensive Care Units to use these anti platelet therapies locally, but also state-wide. We chose Brilinta as it has been shown to reduce not only cardiovascular events but most importantly cardiovascular death. It reduces mortality. Few things we do in medicine actually impact mortality. Combining the strategy of a mechanical procedure that is life saving in the short term and a pharmacologic agent that reduces mortality in the long term is a win-win for all patients.”
This initiative was made possible because of the efforts of Hunterdon Medical Center’s Mobile Intensive Care Unit, the Pegasus Emergency Physician Group and Hunterdon Cardiovascular Associates. In particular Emergency Department Chairman, Ed Spector, MD, Mobile Intensive Care Unit, Medical Director, Michael Prendergast, MD, Martin Hogan, Director of the Mobile Intensive Care Unit, Cardiovascular Interventionalists: William Schafranek, MD and Andrey Espinoza, MD. Additionally, the Physicians of the MICU MAC Committee and the New Jersey Department of Health, Office of EMS.
Pictured left to right: Brian Orlando, Paramedic, James Maguire, Paramedic
Martin Hogan, Director of Mobile Intensive Care Unit, Michael Prendergast, MD, Medical Director, Mobile Intensive Care Unit and Andrey Espinoza, MD, Interventional Cardiologist at Hunterdon Medical Center.