Episode 16- CREATION OF THE CORONARY UNITS
By 1950, advances in cardiac surgery had resolved the majority of its complications - electrical blocks with external pacemakers and potentially lethal arrhythmias with defibrillators.
Possible complications everywhere in the hospital
Complications may still occur in the hours or days following surgery. To the same extent, patients hospitalized because of a stroke may also have the same complications along with the common loss of heart muscle strength that led to the heart failure.
Rapid intervention in the operating room
In the operating room, the procedure to correct the situation is quickly put into action. With staff and equipment on site, the response time is very short, improving the chance of survival of patients.
Longer response time inside the hospital
Response time is longer when complications in patients after an infarction or after a cardiac surgery, even if they are hospitalized at different places in the hospital. This delay is sometimes fatal.
Reflection of Dr. Desmond Julian
In London, Dr. Desmond Julian, exasperated by the number of deaths that could be avoided, wrote in a newspaper: "Several cases of cardiac arrest associated with acute myocardial infarction can be treated quickly if the medical staff is nearby to intervene with the necessary equipment ... "
It was an organizational problem.
Gathering the winning conditions
Two years later, in a few American cities, units were installing a defibrillator, a cardio stimulator, and TV screens to monitor heart rates. The coronary units came to be, clearly meeting the needs.
Skeptics in the room
Data from the United States show a decrease in the mortality of patients who have been hospitalized for myocardial infarction.
Resistance to change
Very disappointed by his failure to form coronary units in London, Dr. Julian left for Australia where he successfully implemented his project.
He published his experience with coronary units; but it was promptly rejected by the prestigious British Medical Journal on the pretext that it is irresponsible to suggest that all victims of a myocardial infarction be hospitalized in one place, without knowing if it will result in a real benefit.
It is sometimes difficult to convince authorities convinced to be the only ones to hold the truth.
The major impact of coronary units
Coronary units will prove their major impact on the mortality statistics of hospitalized patients following a myocardial infarction.
These units have become more specialized over time. Defibrillators, cardio stimulators and cardiac resuscitation personnel were added to the units along with means of measuring the internal pressures of the heart and its ability to pump through a small Swan-Ganz catheter.
These measures, which are accessible at all times, allow medication to be injected into a vein in order to help the heart work effectively.
Lowering the mortality of an infarct
There is no doubt that coronary units have reduced mortality rates since the mid-1960s from 30% to 15%.