Subject(s)
Emergency Medical Services , Fibrinolysis , Myocardial Infarction/drug therapy , Humans , SpainABSTRACT
BACKGROUND: Around 65% of the deaths by acute myocardial infarction are presented in the first hour of the attack when most patients are outside a hospital and it is almost always caused by ventricular fibrillation. Home defibrillation permits these patients to be saved if an integral emergency system is available. METHODS: The cases of ambulatory cardiac arrest resuscitated with no residual neurologic lesions in the province of Ciudad Real were reviewed. The hospital possesses an integral emergency department with an area of communication with one sole emergency telephone (006) and 7 mobile intensive care medical units. RESULTS: Five male patients with a mean age of 54 years were ambulatory defibrillated (4 at home and 1 at work) following cardiac arrest by ventricular fibrillation of acute myocardial infarction (4 inferior localization and 1 anterior). All the patients called for angina, except one for cardiorespiratory arrest. The mean time of delay between the call for help and the arrival of the doctor was 8.4 +/- 6.3 minutes; ventricular fibrillation was witnessed by a doctor in all the cases except for one. Ventricular fibrillation was recurrent in three patients and all required more than one defibrillation. Two patients required mechanical ventilation and vasoactive drugs due to cardiac failure. The complications secondary to resuscitation manoevers are commented upon but the absence of neurologic sequelae is of note. All the patients were discharged and returned to work with the exception of one patient who died due to rupture of the posteromedian muscle of the mitral valve. CONCLUSIONS: Cardiac arrest by ventricular fibrillation in the acute myocardial infarction may be successfully treated out of the hospital with an integral emergency system.
