Gundersen Boscobel overcomes transfer challenges to save STEMI patient

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Gundersen Boscobel overcomes transfer challenges to save STEMI patient

One year ago, on Jan. 14, 2024, just after midnight, Wauzekaresident Brenda Davidson called her best friend in a state of panic. She could barely talk, and she was sweating and grabbing her chest because it hurt so badly.

Brenda's friend headed straight to Brenda's home, arriving within only five minutes - much quicker than an ambulance. Her friend knew there was no time to spare, so they headed to Gundersen Boscobel Hospital.

The roads were snow-covered, and the car could go no faster than 45 mph. There were times Brenda's pain let up, but there were also times it was unbearable.

Brenda arrived at the hospital just before 1 a.m. - approximately 35 minutes after her symptoms began. She was experiencing heartburn for the past two days, which she ignored.

Due to Brenda's friend having called ahead, hospital staff were awaiting Brenda's arrival, and someone came to the car with a wheelchair and quickly took her to an exam room. Soon after, she was moved to one of the trauma bays, where she was immediately attached to the EKG, which confirmed that Brenda was experiencing a STEMI heart attack.

Brenda asked Darren Pipp, MD, to confirm the diagnosis, which he did, and she recalls thinking, "Oh, no!"

Brenda recalls grabbing her chest one last time.

"That's when I died," she says.

That's where her recollection of that evening stops as well.

AHA guidelines provide the right steps

As a participant in the American Heart Association's Get With The Guidelines® program, the Gundersen Boscobel team knew exactly what the science says to do.

Like all heart attacks, STEMI heart attacks require timely treatment to restore blood flow as quickly as possible. Patients require care from a heart catheterization lab, so Boscobel staff contacted the closest tertiary hospital with such a lab - Gundersen La Crosse Hospital, 65 miles away - to request a transfer and helicoptertransport.

Unfortunately, snowy conditions made it too dangerous for helicopter transport, so hospital staff arranged for an ambulance to facilitate the transfer. Because there would be a delay in the patient's arrival to the cath lab, the care team chose to administer thrombolytic therapy called Tenecteplase (TNK), which is used to dissolve blood clots causing the blockage. However, while the team prepared for TNK administration, Brenda's heart stopped.

Staff began CPR. Two shocks were delivered to restore the patient's heart rhythm, and the LUCAS compression devicewas placed. TNK was administered nine minutes after the code began. Resuscitation efforts lasted for 45 minutes before she stabilized.

"I was gone for an hour and a half," Brenda says. "I'm very grateful for how long they worked on me. It's a real miracle."

Once stable, Brenda was given a breathing tube and placed on a ventilator. The ambulance arrived just minutes after she stabilized, but it lacked a critical care crew, which was necessary - because of Brenda's cardiac arrest. Accordingly, she remained stable in the emergency roomfor an additional two hours while waiting for a critical care ground crew to arrive and take over care.

"Our teams are trained to navigate considerable patient transfer dynamics, including inclement weather and needing to pivot transfer units due to changes in patient conditions," says Sandy Duha, BSN, RN, supervisor, Acute Care at Gundersen Boscobel Area Hospital and Clinics. "We're proud to be part of the American Heart Association's Rural Health Care Outcomes Acceleratorand to bring improvements in patient care to the communities we serve."

Once transferred to Gundersen La Crosse, Brenda underwent cardiac catheterization, where hospital staff discovered a 99% artery blockage.

Brenda's next memory was waking up in La Crosse. It was the next day, but she had no idea what time it was or memory of what had happened. She recalls having tubes in her mouth and family surrounding her.

After just three days in the hospital, Brenda was well enough to go home.

Since then, she has nearly fully recovered, so much so that she went to North Carolina to help with disaster relief.

Although it was the ER crew working on Jan. 14, 2024, that saved Brenda's life, she "comes to Gundersen Boscobel all the time" for primary and preventative care. She states that her heart attack simply reinforced her positive feelings about her local hospital.

Gundersen Boscobel a Pathfinder Hospital

Each year, about 285,000 people in the U.S. experience STEMI heart attacks, caused by a complete blockage in a coronary artery. Nearly 40% of people who go to the emergency room with acute coronary syndrome are diagnosed with a STEMI, and only about 25% of them survive.

Gundersen Boscobel Area Hospital gained access to the American Heart Association's Get With The Guidelines® program as a participating Pathfinder Hospital in the Rural Health Care Outcomes Accelerator. Using this quality improvement program offered at no cost to rural hospitals, Gundersen Boscobel can ensure it is following the latest research-based guidelines for STEMI care.