Chest Pain Center v5 Designations
There are three types of designations for the Society of Cardiovascular Patient Care’s Chest Pain Center v5 Accreditation which are based on the facility’s STEMI treatment strategies:
- Chest Pain Center
- Chest Pain Center with Primary PCI
- Chest Pain Center with Primary PCI and Resuscitation
Chest Pain Center: This designation is for those facilities that do not have 24/7 primary PCI coverage every day of the year. Facilities with this designation will have a robust detailed transfer (referral) protocol in place which addresses transfer procedures and/or potential fibrinolytic therapy if the expected first medical contact to intervention time will exceed 120 minutes. Their plans will also include written agreements with:
- EMS ground transport agencies
- Air transport agencies
- Receiving Centers where they send patients for Primary PCI
They empower their Emergency Department physicians with the authority to initiate the reperfusion strategy used based on current environmental conditions and available resources. In a timely manner this group freely shares follow-up and aggregate data with all institutions involved in the care of their STEMI patient.
Chest Pain Center with Primary PCI: Hospitals awarded this designation have Primary PCI available 24/7 every day of the year. This means they have a call team made up of the cardiac cath lab staff and an interventional cardiologist who arrive to the facility within 30 minutes of STEMI activation. These facilities have formal agreements with the facilities that regularly refer STEMI patients for primary PCI. They will also have mapped their STEMI processes to maximize efficiencies which lead to quicker treatment and improved outcomes. This includes:
- The ED physician having the authority to activate the cath lab
- A One-Call Activation System
- No STEMI Diversion Policy
- Formalized back-up protocol for simultaneous STEMI Activations or when the lab is “down”
- Defined roles and responsibilities for all STEMI team members
Chest Pain Center with Primary PCI and Resuscitation: It is estimated that over 60% of all cardiac arrests are directly caused from an acute myocardial infarction. The addition of the Resuscitation designation to Chest Pain Center with PCI accreditation enhances outcomes because the facility will have initiated early strategies such as early recognition, CPR and defibrillation, early intervention with Primary PCI simultaneously with post arrest hypothermia treatment. All mandatory items for the Primary PCI Designation must be met to be eligible to apply for the additional Resuscitation designation.
Patients who have return of spontaneous circulation (ROSC) after cardiac arrest may have had a STEMI. Positive outcomes and ability to ambulate out of the facility exponentially improve with hypothermia therapy and early invasive strategy such as Primary PCI. Therefore, Chest Pain Center with Primary PCI and Resuscitation designated facilities are equipped with a robust hypothermia program which includes policies, procedures, and protocols for post arrest treatment. These facilities must also maintain a ‘No Diversion Policy’ for out of hospital cardiac arrest patients.
This designation also requires a separate Multidisciplinary Resuscitation Committee which has representation from:
- Medical (Cardiologist, Neurologist, Emergency, Critical Care)