The evolution of the coronary care unit
2001; Oxford University Press; Volume: 51; Issue: 4 Linguagem: Inglês
10.1016/s0008-6363(01)00365-0
ISSN1755-3245
Autores Tópico(s)Mechanical Circulatory Support Devices
ResumoWe can now see that the development of the coronary care unit, which Braunwald [1] has called ‘the single most important advance in the treatment of AMI’, was inevitable. But this was not obvious to most cardiologists of the day because so few of them considered the management of myocardial infarction to be a primary concern. They saw the diagnosis and treatment of congenital and rheumatic heart disease to be their main function. In 1956, when I was training under Paul Wood at the National Heart Hospital, I was advised by a Professor of Medicine in London not to become a cardiologist because ‘all the mitrals had been operated on’. Insofar as there was an interest in myocardial infarction, this was concentrated on two modes of treatment — anticoagulants and inotropic drugs. Irving Wright of New York wrote a 1000-page book on myocardial infarction, mentioning cardiac arrest and ventricular fibrillation in a footnote only [2]. The main concern of the book was the use of anticoagulant drugs. There was also a lively interest in the use of noradrenaline in shock; it was claimed that this drug reduced the mortality of this complication from 80 to 50%. There were, however, other developments taking place in the 1950s that led to the explosion of interest in coronary disease that took place in the 1960s. Beck had pioneered open-chest defibrillation and reported the successful resuscitation of a physician with myocardial infarction in 1953 [3]. He wrote, with remarkable foresight, ‘This one experience indicates that resuscitation from a fatal heart attack is not impossible and might be applied to those who die in hospital and perhaps to those who die outside hospital’. A few more cases were described in the succeeding years and it became fashionable for the more enthusiastic surgeons to …
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