Does direct admission to the ICU compared to transfer from medical wards affect outcomes in patients with severe acute myocardial infarction?
Intensive care unit surveillance and specialized measures are crucial for the early phase of acute myocardial infarction, particularly for managing ventricular fibrillation.
Abstract. An analysis of 329 cases with acute myocardial infarction (AMI) treated in an intensive care unit for internal medicine (ICU) during a two‐year period is presented. The series comprises 44% of all hospitalized AMI cases within this period. 191 patients were admitted directly via the emergency department, 138 were transferred from medical wards to the ICU. In principle only the most severe cases were admitted to the ICU. The “direct” and “transfer” groups are compared as to: ( a ) the clinical severity of the disease, ( b ) delay between onset of symptoms and arrival in hospital, and ( c ) incidence and prognostic effect of shock, congestive heart failure and arrhythmias. Special attention is directed to cardiac arrest. In the case of primary ventricular fibrillation occurring in the ICU patients the results were very good. In the case of complicating ventricular fibrillation the results were rather good. Half of the 69 patients with ventricular fibrillation left the hospital alive. In contrast, the results of resuscitation in asystole were very poor. The results obtained very much support the opinion that the AMI patients need special surveillance and possibilities for qualified intensive measures during their stay in hospital, especially in the early phase of their disease.
Linko et al. (Mon,) studied this question.