A STEMI call, a life saved: an hour inside St. Mary’s cardiac catheterization lab
SMGH Foundation
- September 18, 2024
The call rings out through the hospital's PA system: "CODE STEMI, ETA: 20 minutes."
Inside St. Mary's cardiac catheterization (cath) lab, staff are preparing for the imminent arrival.
A STEMI, short for ST elevation myocardial infarction, is the medical term for a heart attack with a completely blocked coronary artery. When blood flow is fully blocked, heart muscle begins to die. Treatment must be swift and precise.
That's why one member of the cath lab team has already been on the phone with paramedics, who in this case, are transporting the patient from a community outside of Kitchener.
The conversation is brief but efficient as the staff member meticulously notes relevant information to the patient's condition: What are his symptoms? When did they start? Is he on medication? An EKG, taken by paramedics, is already being reviewed by the St. Mary’s interventional cardiologist assigned to the case.
As the ambulance approaches, nurses and radiation technologists prep one of St. Mary's two cath labs – the one not already in use to treat a scheduled case.
Tools needed to treat the heart attack are laid out on a table: the long catheter that will be fed through the patient’s wrist or groin and up to his heart, the dye that will allow visualization of blood flow so the blockage can be seen on an X-ray, and the balloon and stent that will restore blood flow.
When paramedics arrive, they bypass the emergency department. The STEMI protocol allows them to use a dedicated elevator to bring the patient directly to the second floor cath lab.
The doctor greets the patient at the entrance and assesses his current condition. Then he’s wheeled into the lab, where staff and paramedics lift him onto the table.
Now, the life-saving procedure can begin.
Meanwhile, in the second cath lab, a scheduled stenting procedure is underway.
Once it wraps up, the room can be cleaned and turned over for the next patient within 10-15 minutes. Staff need to be quick to keep up with the day’s jammed schedule.
Right now, with both labs in use, staff know they’re in a precarious position.
What happens if another emergency case comes through?
"That's the multi-million dollar question," a cardiologist says. "That’s why we need a third lab."
With the STEMI patient secure on the cath lab table, the doctor, nurses and radiation technologists peer at a large screen in front of them.
The doctor uses a foot petal to turn the lights off for a split second as he snaps an X-ray image from the machine hovering over the patient’s chest. The dye, inserted into the patient's artery, allows his blood vessel to appear as a pulsating black streak amid the grey image.
The blockage is pinpointed, and the doctor and scrub nurse prep the balloon and stent. Once inside, the balloon inflates to restore blood flow. The stent will keep the artery open.
The situation in the lab is serious, but none of the staff show signs of panic.
They've been treating dozens of emergency STEMIs per month, a caseload that has increased year after year and is expected to rise further as the population expands and ages.
St. Mary’s cath lab already services roughly 10 per cent of Ontario’s 14 million population, covering a swath of area from Haldimand-Norfolk to Bruce County. Waterloo Region alone, nearing 700,000 residents as of 2024, is expected to expand to one million by 2050.
In 2023, St. Mary's performed roughly 6,000 procedures in its existing two labs, including scheduled and emergent cases, and that workload is taking its toll on the labs’ aging equipment.
As one cardiologist put it, the cath lab is akin to a Toyota Corolla: as a moderately-used family car, it will last 15 years or more. But turn it into a New York City taxicab, it will wear down quickly.
Constructing the third lab – and refreshing the other two with new equipment – will allow St. Mary’s to continue to serve a growing and aging population.
The upgrades will also allow St. Mary’s to expand its cath lab services with new, technologically advanced procedures.
That part is important as the population ages: elderly patients and complex cases aren’t always stable enough to undergo open-heart surgery.
While cardiac staff at St. Mary’s can already treat some heart conditions with minimally invasive techniques, they need technology to expand those services.
Not only will advanced equipment and a third lab allow St. Mary’s to set up new programs, it will also give staff much-needed space. Right now, with both labs operating at full capacity, there’s no time – and no room – to work on advanced minimally invasive techniques.
After roughly 45 minutes, the emergency patient’s STEMI procedure is over. Despite an unexpected secondary blockage, the case goes as planned.
The patient is transferred to the CCU (Coronary Care Unit) to be monitored.
"If he hadn’t come in today, something catastrophic may have happened,” says the cardiologist who worked on the patient. “But that procedure went beautifully."
He’ll be back on his feet by tomorrow.
Want to help support the expansion of St. Mary's Cardiac Catheterization Lab?
100 per cent of new and replacement medical equipment is purchased with donated funds.
