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UT physicians support hospital-EMS partnership to help patients breathe


Physicians on the faculty at The University of Texas Medical School at Houston are providing support to an innovative program for patients with congestive heart failure who are in respiratory distress.

Congestive heart failure is a condition in which the heart can no longer efficiently pump enough blood to the rest of the body’s organs. It can cause fluid to collect in the lungs, which can interfere with breathing. Nearly 5 million Americans are living with heart failure, and 550,000 new cases of heart failure are diagnosed each year.

On Thursday, Memorial Hermann Healthcare System announced a partnership with Houston Fire Department Emergency Medical Services to help these patients breathe a little easier. This month, they began providing Continuous Positive Airway Pressure, or CPAP, to congestive heart failure patients before they even arrive at the hospital.

CPAP, which provides non-invasive positive pressure ventilation, is a mask that can be slipped over the nose and mouth and held by straps around the patient’s head. It splints the airways open, increasing potential for gas exchange, and it also decreases the work of the heart by increasing oxygenation.

For patients with congestive heart failure, CPAP forces fluid out of the lungs. Traditionally, paramedics and emergency medical technicians have performed endotracheal intubation by placing a tube in the throat to relieve pressure and ease breathing before the patient arrives at the hospital. While effective in helping the patient breathe, intubation can be a dangerous process, and it also may increase risk of developing complications and infections, including ventilated associated pneumonia.

Using CPAP machines supplied by Memorial Hermann should have numerous benefits, including reduced exposures to infections, shortened hospital stays and decreased costs.

James J. McCarthy, M.D., assistant professor in the Department of Emergency Medicine at the UT Medical School at Houston and medical director of the emergency center at Memorial Hermann-Texas Medical Center, said the use of CPAP in many cases can eliminate the need to intubate a patient with congestive heart failure.

Since May 1, of the 23 patients who were placed on a CPAP machine while en route to Memorial Hermann-TMC – a primary teaching hospital of the UT Medical School at Houston – only four have required intubation upon arrival at the hospital, McCarthy said.

“If we can keep these patients off a ventilator, they are going to get out of the hospital faster,” McCarthy said. Also, he said, “By doing this, we may be able to prevent the patients from going to ICU at all. They can go straight to a cardiac floor.”

In addition, CPAP can be empowering to patients, allowing them to participate in decisions about their health care because they can speak and don’t have to be sedated as they would if they were intubated, McCarthy said.

David Persse, M.D., physician director of Houston Fire Department Emergency Medical Services, described the new program as a “win, win, win proposition.” The use of CPAP will benefit Memorial Hermann hospitals, congestive heart failure patients and the paramedics, emergency medical technicians and doctors who provide their care.

Thomas Flanagan, chief operating officer at Memorial Hermann-TMC, said, “By providing EMS divisions with additional tools and options, we believe that we can dramatically improve patient outcomes. It is our hope that other hospitals and hospital systems throughout the nation will follow our lead and begin to form partnerships of their own.”

Michael Hewitt, director of respiratory care and pulmonary diagnostic services at Memorial Hermann-TMC, facilitated the partnership to develop an innovative strategy to help save lives and reduce complications associated with intubation.


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