Shore Health opens heart catheterization lab
— Receiving access to cardiac procedures on the Shore can be difficult and in the case of an acute heart attack — deadly, but not anymore.
On Tuesday, May 2, University of Maryland Shore Medical Center of Easton held a ribbon cutting unveiling their new state-ofthe-heart Cardiac Catheterization Laborator y.
The new laboratory will aid in providing top notch care right here on the Mid-Shore that patients previously experiencing a life threatening heart attack such as a STEMI, (ST Elevated Myocardial Infarction) would have had to travel elsewhere to receive. That traveling was the basis of establishing a facility here in the community.
Originally the hospital in Easton had one catheterization lab already, however procedures done there were purely elective and they were unable to assist with heart emergencies such as STEMIs. Now with the capability of two labs the hospital is able to provide both elective procedures and emergency cardiac care.
In the past someone experiencing a STEMI was typically taken to other facilities anywhere from a half hour to an hour away, and it is those precious minutes that could cost the patient their lives.
“Time is muscle,” said Dr. Gary Jones, regional director of cardiovascular and pulmonary services. “So for every minute of delay there is potential loss for viable heart muscle until the blood has been restored to that area.”
“There is 90-minute window,” Jones said. “That is the magic number and the clock starts ticking the minute 911 is called.”
Jones said over the past several years he and administrators from the hospital met with officials from the Maryland Institute for Emergency Medical Services Systems to review exactly how many patients have suffered heart attacks in the area and the incredible number of patients who needed to have these procedures done.
He said then unfortunately they looked at how many of them had to be transferred sometimes 60 to 90 minutes away for those timely acute heart attacks.
Jones said that is the reason for their direction and vision to start this program. He said Easton was geographically the perfect spot to meet the needs of patients that were experiencing a much longer delay in being provided these ser vices.
Jones said those delays were due to traffic, weather, or just the mere distance a patient needs to travel to receive the necessar y care.
“If you were to draw a radius of response time around the approved hospitals in the state that provide these services,” Jones said, “on the western shore there is a tremendous amount of options for patients within 20 minutes — but when you draw that same radius around the middle Eastern Shore there are large voids of areas that require a longer response time.”
Jones said the state looked at all that information and was able to establish a significant unmet need and as a result he said legislation was passed that enabled the hospital to apply for a cer tificate of conformance which would provide the necessary funding required to fulfill that need.
He said the hospital filed for the funding two years ago, and last year on St. Patrick’s Day, March 17, they heard from the state, the funding was approved and he said he remembers it clearly because he and the cardiologist went out and celebrated with a green beer.
Once the funding was approved, the planning and the teams to run them could be established.
Dr. Jeffery Etherton is part of that team and said “We have everything available to us right at our fingertips.”
“One of the best labs in the state,” Etherton said. “A state-of-the-art lab with all the equipment and things that you would need to have these procedures performed.”
Etherton together with Dr. Gabriel Sardi specialize in percutaneous coronary intervention (PCI) also referred to as angioplasty with stent placement.
Etherton said he deals with the arteries to the heart — the blood flow or lack of rather.
He said for his specialty the catheterization labs function in two ways. They can provide information using catheters that inject dye into the arteries of the heart to determine the anatomical structures and blood flow through those arteries and it can look for blockages which can cause chest pain or a STEMI if those arteries are blocked completely.
“We are capable of passing a thin little wire — a balloon or a stent into those arteries and unblock them to restore fresh blood flow to the heart to stop a heart attack or alleviate chest pain,” Etherton said. “The second labs affords us the capability of very quickly getting a patient on the table here in the hospital and have this life-saving procedure performed.”
“We have to not only have the patient into hospital from the beginning of that terrible event occurring to them, said Etherton. “But on the table in the catheterization laboratory and a balloon opening that artery within 90 minutes.”
“So the clock is ticking immediately when that happens, studies have shown that if you get the artery open within that 90 minutes the patient has a six times greater chance of living,” Etherton said.
Ether ton said aiding in the response time is the ability to have the newest equipment as far as imaging and that it is as as good as any lab in the entire state with incredible resolution to see and measure.
“We can actually place a very thin catheter inside the artery and take a picture to make sure our stents are in the right place, that they are the correct length,” Etherton said. “We can measure the flow through the arteries as well, and we can record the images and play them back.”
But Etherton said it’s not only the equipment that makes this new unit so special.
“It’s the human aspect of it too,” Etherton said. “We have assembled a team whose specialty is to assist us performing these procedures — we have highly skilled nurses and technicians working beside us. It’s that all together package that makes it a state-of the art.”
Dr. Benjamin Remo is also part of that team and his specialty is electrophysiology. He said he is like the electrician and Etherton and Sardi are like the plumbers.
Dr. Remo monitors the electrical system of the heart and said the heart actually has a group of specialized cells that run throughout and it coordinates to the different areas of the so that it can pump as efficiently as possible.
“When the electrical system is abnormal it can lead to abnormal function known as an arrhythmia,” Remo said. “With our population here on the Eastern Shore we see a lot of arrhythmia.”
He said people may not know that they have an arrhythmia but they may experience the symptoms of one — racing heart or palpitations, shortness of breath, fatigue, chest pain or may even pass out. He said some abnormal heart rhythms can cause death if they are dangerous enough.
The traditional way to deal with an arrhythmia was with pacemakers, defibrillators, or medications and when all of these options failed the next step is an electrophysiology study — EP studies, which include putting artificial wires up through the leg and into the heart and measure the electrical system of the heart.
“I relate it to when an electrician comes to your house and they have a wire finder,” Remo said. “They are trying to find out if the wires are functioning properly or not.”
An electrophysiologist’s tools include “an extremely advanced computerized mapping equipment that we can actually map out what the heart looks like on the inside,” Remo said.
He equates it to one of the most complicated videos games ever played. He said it is that mapping that allows his team to place catheters in the heart at the correct location without damaging the normal heart structures.
“Dr. Remo has a catheter that has twenty different sensors,” Jones said. “It is able to monitor simultaneously twenty different parts of the heart — it’s fascinating.”
“You take a regular EKG and put it on steroids — that what he is looking at.” Jones said. “It helps him to find and identify the electrical irregularities and he can then perform a catherization.”
Remo’s equipment is mobile and can travel from lab to lab.
“Having that equipment mobile is an incredibly important aspect,” Remo said.
“Because my procedures tend to be a little on the longer side and by nature are elective procedures,” Remo said. “We definitely need two labs to accommodate all the patients we anticipate seeing, especially because with Dr. Etherton’s procedures they are a matter of life and death — an immediate thing.”
Remo said the labs will also ease burdens on emergency medical services and emergency rooms here and in other areas.
“We have had a lot of success with patients who were struggling with these symptoms despite the use of medication and devices,” Remo said. “You can imagine that’s a problem for patients because they are already fatigued from their symptoms but now they have fear and anxiety.”
Those concerns led to a lot of emergency room visits, but now these patients can have procedures done locally rather than driving a long distance.
Along with these talented doctors there is a team of dedicated nurses and support staff that form two teams and work around the clock, 24 hours a day seven days a week. The two teams rotate calls and Jones said he can not say enough about their dedication.
“They are on call every other week,” Jones said. “Every evening and every weekended that significantly impacts what they can do in their personal lives and to me, that’s a pretty significant sacrifice.”
“Remo and Etherton live in this community,” Jones said. “They don’t travel here, they are dedicated to providing this ser vice to our area.”
“Jeff (Etherton) and I are the two newest members to this group,” Remo said.
“This group has been here for 35 years and all of us take pride in the fact that we live here,” Remo said. “It’s a privilege to take care of our neighbors who are in this community with us and all the hard work Gary (Jones), Jeff (Etherton) and Gabriel (Sardi) have done. I feel like we are well placed to take care of our community here on the Eastern Shore for at least 35 more years.”
“The entire cardiac team that has been here for a long time is just fantastic and we are now a new extension of them really,” Etherton said.
“When we dedicated ourselves to provide this service for the community, we knew we would have to provide it 24 hours a day, 7 days a week,” Etherton said. “We care for community that’s the importance of this.”
“We didn’t just come here from Baltimore, Washington or Philadelphia and to just do a procedure every now and then; we live here — we are neighbors,” said Etherton. “We provide this to the community — to the whole five -ounty region on 24/7 basis and if we say we are going to do it, we have to be here — we feel honored to do it for this community — we just feel very blessed that the university of Maryland and Shore Regional has us here to do it for the community.”
Etherton adds that they all benefit from this as well because they are giving back to their community and said it is a wonderful opportunity.
Since the lab opened in the end of March, the teams have performed 20 interventions on an elective basis.
“Several of them have been fairly difficult procedures,” Etherton said. “They are ones that in the past that would have been done in Washington, Baltimore or Philadelphia but we were able to do them here.”
Jones said there will still be patients from the region who still will be taken to other approved centers simply because the transport time will be quicker.
“It’s not about getting everyone to come here,” Etherton said. “It’s about getting the patient to the care they need within that 90-minute window. It’s a matter of what is the best overall outcome for the patient.”
Jones said it is important to acknowledge the wonderful emergency service providers, the post-op nurses and everyone else who aids in saving and ensuring the lives of their patients. He said it is a team effort from start to finish.
On Tuesday, May 2, University of Maryland Shore Medical Center in Easton held a ribbon cutting ceremony for their new state-of-the-art Cardiac Catheterization Laboratory. Pictured from left are Bob Frank, senior vice president for operations, Dr. Timothy Shannahan, Dr. Jeffrey Etheron, John Dillon, chairman of the hospital board, Dr. Gary Jones, regional director of cardiovascular and pulmonary services, Dr. Benjamin Remo, Dr. Gabriel Sardi and Ken Kozel the hospital’s president and CEO. The ribbon was cut in the new percutaneous coronary intervention laboratory, recently completed.
On Tuesday, May 2, University of Maryland Shore Medical Center in Easton held a ribbon cutting ceremony for their new state-of-the-art Cardiac Catheterization Laboratory. Pictured above is the large screen that will enable the doctors to see images of inside the heart obtained in many of the new procedures now available in the labs.