Mobile Coronary Care Unit Research Articles

Sudden cardiac death: A retrospective and prospective study

Since the inception of mobile coronary care units (MCCU), patients with sudden cardiac death (SCD) saved by advanced emergency medical technicians (EMT-A) can be studied retrospectively and prospectively. Forty-eight cases of SCD found in ventricular fibrillation (VF) were successfully resuscitated. Only 32% had a myocardial infarction. Most survivors were New York Heart Association (NYHA) class I or II. All class IV survivors with severe congestive heart failure died within 45 days. All class II survivors had angina as the limiting factor. Of all patients with VF, 23% survived. Eighty percent of survivors were class I or II and have resumed previous lifestyles. No clear cut symptom complex was identified. Rescue response time was generally less than five minutes. Intracardiac medications were administered without complications. Empirical administration of sodium bicarbonate correlated poorly with arterial blood gas determinations.

Cardiac Arrest and Resuscitation

Since the first successful electrical defibrillation of a human heart 27 years ago, different disciplines have dominated the field of cardiac resuscitation: first physiology, then surgery and anesthesiology, and now cardiology. All these disciplines and more are well represented in this edition. Once again, the bibliography is almost all new and the basic science sections adequately cover the mechanisms of cardiac arrest, the pharmacology of resuscitation, and elective cardioplegia. Because 250,000 deaths from acute myocardial infarction occur before patients reach the hospital, the chapters on mobile coronary care units and the logistics of resuscitation outside the hospital have been expanded. Also, a new chapter on "The Spectator Heart," as, eg, at football games, has been added. For the neophyte "reanimatologist," the cookbook-type appendix on resuscitation technique is succinct, timely, and useful. For those with more indepth interests, the section on pitfalls, precautions, and complications is particularly helpful. In 1974, only

Reduction of prehospital, ambulance and community coronary death rates by the community-wide emergency cardiac care system

Initiation of quick prehospital cardiopulmonary resuscitation and emergency cardiac care completed the total system needed to provide emergency and convalescent coronary care for a community. Subsequently, annual community rates for coronary death during ambulance transport fell by 62 per cent and for prehospital coronary death by 26 per cent in people under 70 years of age. In cardiac arrest due to acute myocardial infarction, prompt successful prehospital correction of ventricular fibrillation and asystole yielded long-term survival in two thirds of cases. This 66 per cent success rate of prehospital cardiopulmonary resuscitation and emergency cardiac care is identical to contemporary international experience. Precordial thump-version with the fist and precordial fist pacing appeared logical additions to prehospital cardiopulmonary resuscitation and emergency cardiac care technics. Community lives saved yearly were 15.2 100,000 people aged 30 to 69 years and 6.4 100,000 total population. Simultaneously, annual community rates for coronary death as a cause of death and coronary death per 1,000 people fell significantly by 15 and 17 per cent, respectively. Unquantifiable influences included prehospital relief of ischemic chest pain; prehospital correction of acute dysautonomia; prehospital abolition of otherwise prefatal dysrhythmias; similar treatment for acute myocardial infarction in the emergency department, in the inhospital mobile coronary care unit and in the progressive intermediate coronary convalescent unit; and general community education through the media of newspapers, radio and television. The present frequency of coronary death during ambulance transport, 9 to 22 per cent of prehospital coronary deaths in this and other surveys, suggests that the prehospital cardiopulmonary resuscitation and emergency cardiac care component needs improvement in many communities. By reducing prehospital and ambulance coronary death rates, prehospital cardiopulmonary resuscitation and emergency cardiac care for acute myocardial infarction constitutes an essential component of the total system approach to emergency coronary care. Since prehospital cardiopulmonary resuscitation and emergency cardiac care have cheaply and effectively expedited and abbreviated hospitalization for acute myocardial infarction, and lowered community death rates from coronary artery disease, its adoption throughout the United States and the western world seems justified.

Resuscitation of patients with ischaemic heart disease before admission to hospital

This paper provides data about the efficacy of resuscitation before hospital admission of 139 patients with myocardial infarction. Successful resuscitation was effected in 43 (30.9%) patients, of whom 29 (20.9%) survived and were discharged from hospital. An organizational scheme is given for resuscitation measures before admission, in which the following teams participate: premedical, general first-aid ambulance team and specialized first-aid cardiological team (Mobile Coronary Care Unit, MCCU — definition of World health Organization). The effectiveness of resuscitation depends upon the patient's age, and the presence and degree of circulatory insufficiency before clinical death. It proved possible to revive successfully patients of advanced age and with preceding mild or moderate acute circulatory insufficiency. Resuscitation was not successful in patients with preceding severe circulatory insufficiency. Blood electrolytes were studied in the post-resuscitation period. There was a statistically significant decline in plasma potassium ion concentration. Potassium salts should be introduced in the form of a polarizing mixture, especially to patients with an irregular cardiac rhythm in the post-resuscitation period. Problems of intracardiac injections of drugs, intubation, and pervenous electric pacing in patients with myocardial infarction during resuscitation are discussed. It has been concluded that the optimum form of resuscitation before admission of patients with myocardial infarction involves rendering maximal aid at the place of occurrence of the infarction.

Version of Arrhythmia

To the Editor.— Four years ago, termination of ventricular tachycardia by a simple, brisk blow of the fist over the heart became hospital coronary care unit practice. 1 We have seen four such patients survive prehospital and hospital care and return to active life. Recently, thumpversion was justifiably incorporated into the revised standards for cardiopulmonary resuscitation and emergency cardiac care (227:833, 1974). Resultant electromechanical transduction provides energy adequate to depolarize a reentry pathway and thereby abolish ventricular dysrhythmias. We recently observed an 81-year-old man, with a history of myocardial infarction ten years earlier, who had sudden palpitation and became weak and dizzy. When seen by the mobile coronary care unit team, he had new, low-frequency, high-amplitude atrial fibrillation and frequent ventricular ectopic beats. He was placed on a stretcher, monitored continuously, and treated with oxygen. A mile from the hospital, the ambulance drove over a partially filled trench in the

Life support stations

A life support station (LSS), either mobile or fixed, may be established in areas of population density where patients with acute coronary attack or acute myocardial infarction can receive prompt medical care. The mobile LSS are represented by mobile coronary or intensive care unit. The fixed LSS are ideally established in the Emergency Departments of different hospitals. They may also be considered for the following locations: factories, large office buildings, metropolitan airports, large railroad stations, stadiums, and convention halls. The functions and potential advantages of a LSS include the following: initiation of early care with monitoring of the vital signs and electrocardiogram, prevention and management of serious cardiac arrhythmias, institution of cardiopulmonary resuscitation including defibrillation, stabilization of the patients' condition before transfer, and reduction of the incidence of cardiogenic shock and overall mortality.

Life Support Stations

A life support station (LSS), either mobile or fixed, may be established in areas of population density where patients with acute coronary attack or acute myocardial infarction can receive prompt medical care. The mobile LSS are represented by mobile coronary or intensive care unit. The fixed LSS are ideally established in the Emergency Departments of different hospitals. They may also be considered for the following locations: factories, large office buildings, metropolitan airports, large railroad stations, stadiums, and convention halls. The functions and potential advantages of a LSS include the following: initiation of early care with monitoring of the vital signs and electrocardiogram, prevention and management of serious cardiac arrhythmias, institution of cardiopulmonary resuscitation including defibrillation, stabilization of the patients' condition before transfer, and reduction of the incidence of cardiogenic shock and overall mortality.

A mobile life support stretcher system

Despite the advantages of hospital Coronary Care Units, statistics indicated the number of fatalities from heart attacks were not reduced. Many victims of myocardial infarction and cardiac arrest died prior to arrival at the hospital. In order to provide mobile life support in cardiac emergencies a survival stretcher system was designed for use in a mobile Coronary Care Unit. The system was instituted and evaluated at Lenox Hill Hospital Emergency Department. After several months use, the stretcher was redesigned according to criticisms by Lenox Hill Staff and put into service for further evaluation. The stretcher provided the means for a minimum number of personnel to treat cardiac emergencies immediately and to monitor patients' conditions continually.

Emergency Infarction Treatment

<h3>To the Editor.—</h3> Your editorial, "Early to Bed and Early to Rise" (225:1527, 1973), unwittingly perpetuates the myth that emergencies are best handled if the patient reaches the hospital as quickly as possible. The editorial reads ... the patient is urged to call an ambulance—a mobile coronary care unit, if available—in order to reach the hospital at the earliest possible moment. This statement is amplified in the next sentence that reads "this may mean the difference between life and death." We recently completed a study of the factors entering into a patient's decision to come to a hospital emergency department. Factors influencing the type of conveyance used showed that fewer than 2% of patients traveling by ambulance had any wish or desire for the potentially skilled help available aboard the ambulance. Rather, the reasons for using ambulances involved needs for additional manpower, "official policy," and the apparent need for speed in

Sudden Death in Nonhospitalized Cardiac Patients

Sudden death due to coronary heart disease in nonhospitalized patients in southeastern Montgomery County, Maryland, was investigated over one year to determine potential benefits from various intervention techniques. One hundred thirty-eight patients between the ages of 35 to 75 were studied. Fifty-seven percent had a history of heart disease. Premonitory symptoms were present in 65%; only 22% had chest pain. Three fourths died at home; 4% at work; 8% in the ambulance; and 8% in a hospital emergency room. Fifty (36%) died unwitnessed, but 15 of these had informed someone of acute symptoms before being left unattended. Previous symptomatic heart disease was associated with a more rapid demise. Based on the time of cardiac arrest and the call for emergency aid, no more than 22% could have been aided by mobile coronary care units.

Sudden death in nonhospitalized cardiac patients. An epidemiologic study with implications for intervention techniques

Sudden death due to coronary heart disease in nonhospitalized patients in southeastern Montgomery County, Maryland, was investigated over one year to determine potential benefits from various intervention techniques. One hundred thirty-eight patients between the ages of 35 to 75 were studied. Fifty-seven percent had a history of heart disease. Premonitory symptoms were present in 65%; only 22% had chest pain. Three fourths died at home; 4% at work; 8% in the ambulance; and 8% in a hospital emergency room. Fifty (36%) died unwitnessed, but 15 of these had informed someone of acute symptoms before being left unattended. Previous symptomatic heart disease was associated with a more rapid demise. Based on the time of cardiac arrest and the call for emergency aid, no more than 22% could have been aided by mobile coronary care units.

The Mobile Coronary Care Unit

To the Editor.— The excellent article by Drs. Feinleib and Davidson again emphasizes the large percentage of people with coronary artery disease who die outside medical facilities. However, some of the comments they make regarding their data are open to dispute. The Mobile Coronary Care Unit (MCCU) is not the final answer to this problem, but does present a valid approach. They mention the high operating expenses of a mobile CCU, but this is not necessarily the case, as shown by a detailed costing of such a system. 1 There is no need for a costly specialized vehicle; an ordinary van with equipment is all that is required, and the personnel from the hospital CCU can also man the mobile unit. The authors express the opinion that the greatest delay in the care of a patient with acute myocardial infarction is his own unwillingness to call for help. A recent

The mobile coronary care unit

The mobile coronary care unit

Bradycardia and its complications in the prehospital phase of acute myocardial infarction

To elucidate the mechanisms of sudden death in the prehospital phase of acute myocardial infarction, the records of 84 patients with acute myocardial infarction transported by the mobile coronary care unit of Montgomery County, Maryland, were studied. Twenty patients (24 percent) had bradycardia, 10 receiving no pharmacologic therapy other than narcotic drugs. All 20 survived transportation and hospitalization, whereas 7 of the 64 patients without bradycardia died. Ten (12 percent) had systolic blood pressure values of 90 mm Hg or less, and bradycardia was an associated finding in five. Thus, in a suburban-metropolitan population of the United States, bradycardia occurs frequently during the prehospital phase of acute myocardial infarction. Although the overall incidence of hypotension is low by the time a patient calls for medical aid, hypotension is not uncommon in patients with bradycardia. The therapeutic implications of these observations depend on an elucidation of the natural history of acute myocardial infarction with bradycardia in the presence and absence of hypotension.

Delays in Reaching the Cardiac Care Unit: An Analysis

Seventy-five patients were studied with regard to the occurrence of delays before entering a cardiac care unit. The greatest delay was the decision time, the interval between the onset of acute symptoms and a patient's decision to seek medical help. Second most important cause for delay was physician delay. A lengthy waiting period in the emergency room was also found. Transportation time appeared of less consequence when other delays were considered; thus the need for mobile coronary care units was questioned. The results indicate that community oriented educational programs are required to more fully inform the population at risk of symptoms of acute myocardial infarction. Earlier hospitalization of patients with chest discomfort by physicians is also needed. Furthermore, individual hospital evaluations similar to the present study, by underscoring where significant delays occur, may help expedite the care of these patients.

Mobile Cardiac Care: A Community Approach.

Meeting Abstracts1 May 1972Mobile Cardiac Care: A Community Approach.Richard P. Lewis, M.D., F.A.C.P., Stephen F. Schaal, M.D., John T. Frazier, James V. Warren, M.D., F.A.C.P.Richard P. Lewis, M.D., F.A.C.P.Search for more papers by this author, Stephen F. Schaal, M.D.Search for more papers by this author, John T. FrazierSearch for more papers by this author, James V. Warren, M.D., F.A.C.P.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-76-5-865_3 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptAlthough mobile coronary care units can save lives, the prototype systems have proved relatively expensive. Furthermore, it has not proved feasible to have physicians accompany the unit. After 26 months of experience directly supervised by a physician, the Columbus unit was incorporated into the municipal fire rescue squad system. Physician attendance on the vehicle was terminated. Rescue squad personnel were trained in diagnosis and therapy of cardiovascular emergencies, including administration of certain drugs. Analysis of results with (before) and without (after) a physician present are given below.The patient population seen before and after was comparable. The paramedical team sees... This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAuthors: Richard P. Lewis, M.D., F.A.C.P.; Stephen F. Schaal, M.D.; John T. Frazier; James V. Warren, M.D., F.A.C.P.Affiliations: Columbus, Ohio PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited byBeneficial effects of atropine in the pre-hospital phase of coronary careRecurrent “Sudden Death”A revolution in coronary artery disease 1 May 1972Volume 76, Issue 5Page: 865-865KeywordsCardiac care unitCardiovascular therapyDrug administrationDrug therapy ePublished: 1 December 2008 Issue Published: 1 May 1972 PDF downloadLoading ...

Prehospital care of acute myocardial infarction.

It has been estimated recently that half of deaths among the patients with acute myocardial infarction occur before they ever reach the hospital for definitive medical care. One of the major reasons for the high incidence of death was attributed to delays in reaching medical care, involving patients themselves, physicians, transportation, and receiving areas of the hospital. In order to reduce this high mortality substantially we should focus our attention on the prehospital care of this disease, which may include several major approaches. A. To shorten the delay in securing medical care: 1. Public education, with emphasis on the early warning symptoms and signs of acute myocardial infarction, and the need and importance of seeking early medical care, with special attention directed toward the high-risk coronary patients. 2. Professional education. 3. Mechanisms to direct and/or bring patients with suspected or proven acute myocardial infarction promptly to the system of medical care with special emphasis on the utilization of a telephone information center and provision of rapid transportation. B. Establishment of emergency life-support stations for screening, monitoring, and early stabilization of cardiac arrhythmias: 1. Fixed. a. Emergency department of hospitals, preferably with an attached precoronary care area. b. Areas where many employees are working on weekdays. c. Areas where many people move in and out from day to day. d. Areas where there is periodic concentration of mass population. 2. Mobile. a. Mobile coronary care unit. b. Mobile intensive care unit. C. Prevention of sudden death: 1. Study of mechanism and clinical environment of sudden death. 2. Development of techniques for early diagnosis and management of acute myocardial infarction prior to inception of symptoms. 3. Identification of individuals prone to sudden death. 4. Preventive measures directed toward the individuals prone to sudden death. a. Effective control of risk factors. b. Intermittent or periodic electrocardiographic monitoring in these individuals. c. Long-term antiarrhythmic therapy for these individuals. d. Possibility of implanting an automatic defibrillator in patients with previous myocardial infarction or in those recovered from ventricular fibrillation. 5. Early administration of antiarrhythmic drugs in patients with suspected or proven acute myocardial infarction.

Adrenal corticosteroids--physiological considerations.

Appreciation of the fact that delay can be due to referral through the general practitioner has led to an attempt to bypass primary medical care in acute myocardial infarction in the Belfast coronary care scheme.2 This delay operates in most parts of the British Isles, however, and further separates the patient from coronary care by a median time of 33 minutes in Doncaster. It seems clear from our results., summarized in Fig. 3, that the provision of a mobile coronary care unit to be alerted by general practitioners cannot be expected to contribute very much to the saving of life after acute myocardial infarction, especially in an area such as Doncaster, where ambulance delays are minimal.

The Mobile Coronary Care Unit and The Intermediate Coronary Care Unit in The Total Systems Approach to Coronary Care

A system of patient care is described in which the patient with acute myocardial infarction is under the umbrella of continuous electrocardiographic monitoring outside the hospital, in the emergency room, in the coronary care unit and, finally, in a mobilization unit which is referred to as the intermediate coronary care unit. The reasons why patients outside the hospital experience a long delay in arriving at coronary care are reviewed. Each community must examine the problems involved in the delay of coronary care and make appropriate adjustments in their plan for patients with acute myocardial infarction to overcome all and any delays. In addition to the high mortality rate of patients prior to onset of coronary care, there is also a substantial mortality in patients who have been discharged from the coronary care unit. The article describes a system for dealing with this latter problem.

A mobile coronary care unit: an evaluation for its need.

Although the few existing mobile coronary care units have proved effective, the establishment of a new unit is expensive. In order to determine the usefulness of such a unit an evaluation of present patterns for care of the acute myocardial infarct patients and patients dead on arrival at a west-side Cleveland hospital was made. The greatest delay in the care of the acute myocardial infarct patient was his own unwillingness to call for help. The median time for transport of patients to the hospital was 25 min. The study of patients dead on arrival at the hospital showed that the time needed for rescue squads to reach the patients was too long in almost all cases for effective resuscitation to be accomplished. This study shows that present transportation facilities for the acute myocardial infarct patients in this community are adequate. Added equipment and training of personnel for the existing units could obviate the need for a centrally based and more costly mobile coronary care unit.