| Summary: | A mobile coronary care unit readied about 20% of the population at risk with ischaemic heart disease. It was limited in its ability to reach patients within an hour of the onset of their symptoms, particularly patients with sudden cardiac death. It was much more successful at reaching these patients than the pre-existing intensive care facilities. Beyond the first hour after the onset of symptoms the mobile coronary care unit made a significant impact upon the mortality from ischaemic heart disease, measured in relation to the population at risk. It did this by resuscitating patients with cardiac arrest in the vicinity. There was no evidence of the prevention of deaths by any other method, either the prevention of serious arrhythmias by prophylactic treatment or the reduction of the incidence of cardiogenic shock. The mobile unit was useful in providing information about why some patients delayed in calling for help after the onset of their symptom. The delay was, in general, a rational response to mild symptoms - unfortunately such symptoms were often misleading for many such patients with mild symptoms had a cardiac arrest later. Data collected in the unhurried atmosphere of the mobile coronary care unit gave sate information about factors which influenced most strongly the final outcome for patients in terns of their final diagnosis and their likelihood of having serious complications later in their hospital treatment. The initial electrocardiogram was particularly useful in this regard. No patient group was defined which was completely safe from all complications but a small group could be defined which was unlikely to have a cardiac arrest and a grading of severity could be easily achieved, so that for example scarce intensive care facilities could be best utilised by patients with the worst prognostic score, i.e. those most likely to have complications. The mobile coronary care unit was an effective addition to the hospital services for patients with ischaemic heart disease as far as resuscitation from cardiac arrest was concerned. It did not significantly increase the incidence of cardiac arrhythmias while the patients were in the unit and did not increase patient anxiety more than admission to a hospital general medical ward.
|
|---|
