Pre‐hospital Management of Acute Myocardial Infarction

Atherosclerosis of the coronary arteries is recognized today as a major health problem in the United States, since 600,000 deaths are attributed to it annually (Vital Statistics, 1966). The medical profession and the general public are well aware of the important studies of its pathogenesis and prevention. However, the profession has been so preoccupied with these phases of investigation that the mechanism of death and possible modes of correction have remained obscured until recently. In 1956 Claude Beck of the Western Reserve University suggested that ventricular fibrillation may be the mechanism of death in many instances of arteriosclerotic heart disease (Beck, Weckesser and Barry, 1956) . He popularized the phrase "hearts too good to die" to promote the concept that death in coronary disease was frequently electrical and not always associated with a terminal pathologic process . In 1960 Dr. Adelson reported a study of 500 consecutive sudden deaths attributed to coronary disease, discovering that only one-third of these patients had a recent thrombus or myocardial infarction, while two-thirds of the group had no "new" anatomic disease (Adelson and Hoffman, 1961). This provided further support to the concept that the lethal mechanism in arteriosclerotic heart disease, more appropriately termed ischemic heart disease, was unrelated to the degree of myocardial damage and most likely was an electrical phenomenon. Electrocardiographic monitoring of patients with acute myocardial infarction in coronary intensive care units has subsequently documented that ventricular fibrillation was frequently the mode of death in these patients. The 30 percent decrease in hospital mortality rate of patients with acute myocardial infarction has been attributed to the coronary intensive care unit system with its technique of instant defibrillation (Day, 1956) . However, improved supportive medical therapy and the use of