A coronary-care unit in the routine management of acute myocardial infarction.

Abstract The design, equipment and staffing of the-six-bedded coronary-care unit at the Royal-Infirmary, Edinburgh are described. As a result of the-admission and discharge policy which is outlined, 624-patients were admitted to the unit from April, 1966, to-May 1967. 570 of these were emergency "routine"-admissions and 400 had sustained an acute myocardial-infarction. Theses 400 cases are presented in detail. There-were 70 deaths (55 in the unit, 15 in the wards after-transfer), and a high proportion were due to causes such-as shock, asystole and severe cardiac failure, which at-present are mostly irremediable. Ventricular fibrillation-developped in 44 patients and 23 (52%) left hospital after-successful resuscitation. Asystole developed in 10 patients-and only 1 lefts hospital. As a result of successful treatment-of cardiac arrest the mortality was changed from 22 to-17.5%, a 20% reduction. A coronary-care unit can be-expected to make the maximum impact on mortality from-myocardial infarction if admission is-restricted to patients whose symptoms-began within the preceding forty-eight-hours and to those who later develop-serious arrhythmias while being treated-elsewhere. The construction, equipment-and, particularly, the staffing requirements-make the etablishment of units an imprac-ticable proportion in the majority of hos-pitals. One the main objectives of a-coronary-care unit should be to develop and-evaluate new techniques and methods of-treatment for more general application.