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                                              50 Years of Acute Coronary Care

 

May 20, 2012 marked the 50th anniversary of the opening of the world’s first coronary care unit, the Bethany Hartford Coronary Care Unit at Bethany Medical Center, Kansas City, Kansas.  This simple but practical idea has saved thousands of lives and has added greatly to our knowledge of the electrical events that occur in an acute myocardial infarction.   It also ushered in a new era for nurses where they became active participants in the treatment of patients. 

If you were so unfortunate as to suffer a sudden cardiac arrest prior to 1956, your chances of survival were nil.  The only thing that could be done for you was open chest cardiac massage.  Not very convenient unless you were already under anesthesia on an operating room table.

Between 1956 and 1960, two major developments changed this dramatically.  The first was the discovery by Jude, et al at John’s Hopkins, that closed chest cardiac compression could effectively perfuse the body.  The second was the discovery by Zoll,  at Harvard, that the heart could be defibrillated with an external defibrillator.  Neither of these developments alone would have been helpful, but together they provided an effective tool for the treatment of sudden cardiac arrest.  This led to the development of the Crash Cart and the term Code Blue at Bethany Medical Center in 1960. 

Within a few months every hospital had a Crash Cart.  Early experience showed that unless CPR was begun within a minute or two of cardiac arrest the results were extremely poor.  This led Dr Hughes Day and others at Bethany Medical Center to the idea of putting acute MI patients in close proximity to a monitor/defibrillator. Thus, was born the Coronary Care Unit. 

Supported by a grant from the Hartford Foundation , the Bethany Hartford Coronary Care Unit was opened on May 20, 1962.  The initial unit consisted of four private rooms and a seven bed open ward which was also used as a Medical Intensive Care Area.  When a separate Medical Intensive Care Area was opened in 1970, the area was remodeled into a seven private bed unit. 

Prior to 1962, the death rate from acute myocardial infarction among patients admitted to a general hospital was in the range of 30%.  Today, every hospital has some kind of acute coronary care area and the mortality rate averages 3%.

Dr. Day has passed away and so has Bethany Medical Center, but his contribution will live forever.  Rest well Hughes.  You made a difference.

 

Sherman M. Steinzeig, MD

Medical Director,

Bethany Hartford Coronary Care Unit

1969-1985