6 June 2024

Maharaj Nakhon Chiang Mai Hospital has implemented an operational measure which increases the chance of survival in critically ill heart-attack patients.

The hospital, part of Chiang Mai University’s (CMU) Faculty of Medicine, is the first and only medical facility in the country to integrate its catheterisation lab (Cath Lab) and Cardiac MRI.

“At other hospitals, they are in separate zones or even on different floors,” Asst Prof Dr Pannipa Suwannasom, an interventional cardiologist and faculty member said.

Special Expert Prof Dr. Bannakij Lojanapiwat, dean of the faculty, said the integration aims to minimize “door-to-door” time, to improve the patient’s chances of survival and recovery, adding “Patients with acute coronary syndrome need urgent medical assistance. Every minute counts.”

The integration of the Cath Lab and Cardiac MRI facilities into the emergency room (ER) has now transformed the hospital into the largest one-stop-service ER in Thailand’s North. “This move can save lives,” the hospital’s director Asst Prof Dr. Narain Chotirosniramit commented.

 A matter of life and death

Recognising that timely treatment can save patients’ lives, the hospital even provides “smart ambulances”. Dr. Bannakij said, with such well-equipped vehicles to transport patients, it is possible to diagnose the patients’ condition during the ride. So, as soon as the patient arrives at the hospital, the right people and equipment are ready.

“Our team should be able to perform the much-needed surgery within 30 minutes. Chances of survival are therefore improved,” Dr. Bannakij said.

Standards require that, once a patient with heart failure reaches the ER, their condition must be diagnosed with electrocardiogram within 10 minutes and be taken to surgery within 90 minutes.

Dr. Pannipa said the medical team at her hospital believes it is able to perform surgery on patients within 60 minutes, now that the Cath Lab and Cardiac MRI are integrated into the ER – 19 minutes faster than prior to the change.

Dr. Narain said, before the integration, it took 10 to 15 minutes just to move patients from the ER to the Cath Lab on the 8th floor of the building.

“Faster treatment does not just save lives, it also minimises the damage caused by serious heart conditions,” Dr. Pannipa said.

 What is Cardiac MRI?

Assoc. Prof Dr. Arintaya Phrommintikul, director of the Centre for Medical Excellence and a lecturer in medicine at CMU, said cardiovascular MRI supports the diagnosis of heart conditions, the assessment of risks and the monitoring of response to treatment, because it displays blood flow in four dimensions.

“Supported by this modern technology, we can accurately identify if a patient has myocarditis and plan surgery efficiently,” she said.

Available for the medical team now are Pre-Operative CT 3D Printing and VR Advanced Cardiac Imaging, which means a lot in complicated cases.

According to Dr. Arintaya, many patients have been transferred to the Maharaj Nakhon Chiang Mai Hospital from elsewhere, because of the seriousness of their condition.

 

 Categorisation of patients

Pannipa said there are four categories of acute coronary syndrome patients. Grade 1 refers to patients with mild symptoms. Grade 2 are admitted with tightness in the chest. Grade 3 have pulmonary oedema (fluid in the lungs), while Grade 4 are in shock, the most serious condition.

“I can tell you that all Grade 1 patients often survive. Fatalities among Grade 2 patients are between 2% and 3%. For Grade 3, that rises to about 5%. When it comes to Grade 4, however, the chance of survival is only 50%,” she said.

 Thailand’s first heart failure clinic

Dr. Arintaya said the CMU Faculty of Medicine was the first in Thailand to set up a heart failure clinic more than 20 years ago, bringing together experts from relevant fields, to provide accurate diagnoses and effective treatment.

“Our clinic has educated patients and their families about healthcare, so as to engage them in the process of planning and monitoring treatments. With this approach, patients will have fewer symptoms, resume a normal life and can reduce the chance of hospitalisation or death,” she said.