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EICU CAN SAVE LIVES IN MYOCARDIAL INFARCTION IN REMOTE AREAS IN THE DEVELOPING WORLD

Abstract

Introduction: Healthcare is evolving rapidly in urban cities in the developing world but it still remains a challenge in remote areas. Most ICU Units are run with one consultant who cannot cover it 24 × 7×365 days. Night cover duty doctors are present but without adequate expertise in the concerned field. This gap is personified especially in emergency situations like Myocardial infarction (MI) and other cardiac emergencies. We asked the question whether EICU can play a definitive role in remote areas where expert manpower for benefiting patients in a specific situation like an evolving MI. Methods: EICU with access to patient’s real time vitals, hemodynamic parameters, EKG, lab values, audio visuals and smart alerts were used as a tool to diagnose and treat MI when the expert doctor was not available during Off hours. An 11 bedded coronary care unit (CCU) at a remote location was attached to the EICU which provided support 24 × 7 monitoring. Patients with chest pain were evaluated; EKG, lab values and hemodynamic parameters were evaluated remotely at the EICU command centre. As per ACCF/AHA guidelines patients who were candidates for thrombolysis were initiated within 30 min of arrival. During and post thrombolysis close monitoring was done for potential complications and wherever deemed necessary consults were given and interventions made. Results: Implementation of EICU monitoring resulted in significantly improved mortality. Pre-EICU intervention July-December 2012 patients admitted with MI were 90 of which mortality at 30 days was 18. POST EICU from January-June 2013 total 92 patients were admitted with MI with 4 mortalities at 30 days (p value < 0.003). Mean APACHE 2 of patients admitted was 8.2 pre-EICU and 8.4 post-EICU, mean age 56.8 vs 57.2 pre and post EICU respectively. Conclusions: While there is no debate that on site expertise is the best way to provide care to patients, but in places where there is limited expert manpower especially at odd hours EICU can bridge a potential gap and can provide the much needed support in time to save more lives. While here we describe specific intervention as in thrombolysis, we believe this benefit can be extended in to other specific interventions too.