The "EMS to Balloon" (E2B) Challenge!

Patients experiencing ST-segment elevation myocardial infarction, or STEMI (heart attack), have the best chance of a good outcome if they receive percutaneous cardiac intervention, or PCI (angioplasty), within 90 min. of arrival at a hospital. Because most STEMI patients in the U.S. currently do not receive PCI within 90 min., the American College of Cardiology launched a national "Door-to-Balloon" (D2B) Initiative in November 2006 to help hospitals achieve the 90 min. goal.

At present, utilizing a pre-hospital ECG to activate the cath lab is listed as an optional strategy by the D2B Alliance. The EMS to Balloon (E2B) Challenge hopes to build on the foundations of the D2B Initiative. As of March 2007, more than 25 diverse professional societies have endorsed the D2B Alliance and become official strategic partners. Over 500 hospitals nationwide have also signed on, and the list continues to grow. Frequent updates and more detailed information are available at the D2B Alliance

The E2B Challenge promotes the "30-30-30" rule to help providers meet the goal of "EMS-to-Balloon" in 90 min. or less. Each segment (EMS, the emergency department, and the cath lab) has 30 min. to complete their specific task, and each unit operates within a coordinated system that emphasizes parallel processing, real-time communication, teamwork, and smooth transitions. Specific time intervals include: Pre-hospital ECG to hospital door (E2D) < 30 min., Hospital door to cath lab door (D2C) < 30 min., Cath lab door to balloon (C2B) < 30 min.

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