Correspondence

Resuscitation Medicine

N Engl J Med 1997; 337:1695-1696December 4, 1997

Article

To the Editor:

In his review of Life in the Balance (July 17 issue)1 Dr. Safar states, “The mobile cardiac care unit introduced in Belfast in the mid-1960s brought cardiology fellows to heart-attack (not heart-arrest) victims in attempts to prevent cardiac arrest.” This is a misunderstanding of the past 30 years of mobile coronary care in Belfast. The main purpose of the Belfast mobile coronary care unit set up in 1966 (before the widespread availability of thrombolytic therapy) was to bring equipment for defibrillation to the collapsed patient in the community with minimal delay, thus increasing the chance of full neurologic recovery. Since its inception, we have attended thousands of patients with cardiac arrest in the out-of-hospital setting. The physician-staffed unit has also responded to patients with symptoms suggestive of unstable angina or acute myocardial infarction since 1966.

Stephen McMechan, M.D.
David Cochrane, M.D.
Jennifer Adgey, M.D.
Royal Victoria Hospital, Belfast BT12 6BA, Northern Ireland

1 References

1. 1

   Safar P. Review of: Life in the balance: emergency medicine and the quest to reverse sudden death. N Engl J Med 1997;337:206-207
   Full Text

Author/Editor Response

Dr. Safar replies:

To the Editor: My review of Life in the Balance pointed out that resuscitation medicine is more than emergency cardiac care. We need mobile general intensive care units (ICUs), not merely mobile cardiac ICUs, to maximize the chances of survival for victims of all sudden-dying processes, including coma and trauma. My comment concerning the first mobile coronary care unit introduced in Belfast in the mid-1960s1 referred only to that pioneering time, and my understanding is that the primary intent of that remarkable program was “to get patients under intensive care early, correct rhythm disturbance and prevent the development of ventricular fibrillation.”2 I should have added that when such prevention was not possible and ventricular fibrillation occurred, the Belfast group reversed the majority of these cardiac arrests by immediate external countershock. They even succeeded in resuscitating patients who had become pulseless before their arrival, provided effective basic life support had been started immediately.1,2

These firsts of mobile cardiac care in Belfast were followed by similar experiences in Miami, Seattle, and New York City. My review also intended to credit our colleagues behind the Iron Curtain who created the first portable, external direct-current defibrillators. In 1963, I saw mobile general ICUs staffed by physicians in Prague (under the direction of Dr. Bohumil Sefrna) and Moscow (inspired by Dr. Vladimir Negovsky). Their early results unfortunately have remained unpublished in the West. Mobile general ICUs in the West began around 1963 in Mainz, Germany (inspired by the late Dr. Rudolf Frey).

Peter Safar, M.D.
University of Pittsburgh, Pittsburgh, PA 15260

2 References

1. 1

   Pantridge JF, Geddes JS. A mobile intensive-care unit in the management of myocardial infarction. Lancet 1967;2:271-273
   CrossRef | Web of Science | Medline

2. 2

   Pantridge JF, Adgey AA. Pre-hospital coronary care: the mobile coronary care unit. Am J Cardiol 1969;24:666-673
   CrossRef | Web of Science | Medline