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In the late 1960s, American emergency medical services (EMS) began to upgrade from mere Red Cross first aid to systems that now provide sophisticated advanced life support. This revolution in EMS stemmed from two pioneering Belfast reports in The Lancet that described how early out-of-hospital coronary care saved lives. Inspired, a handful of American physicians implemented avant-garde programs in the USA. One such physician, Richard Crampton of the University of Virginia, supported by the university and by Charlottesville-Albemarle Rescue Squad staffs, led an early effort to provide out-of-hospital drug treatment and defibrillation via a mobile coronary care unit (MCCU) ambulance. Half a dozen high-profile local cases, including successful treatment of retired President Lyndon B. Johnson, demonstrated MCCU efficacy to the Virginia and American public via local and national press coverage. The economic feasibility of the MCCU system was established. With two Virginia colleagues, Crampton successfully lobbied for a bill to permit trained nonphysicians to render out-of-hospital cardiac care with no on-site physician. This MCCU-augmented EMS system reduced coronary deaths in Charlottesville and Albemarle County, Virginia. It also stimulated nationwide progress in care by EMS systems that yielded countless lives saved in the succeeding half-century.

Early detection of acute myocardial infarction (MI) is vital in the management of acute coronary syndromes (ACS). Hence we compared the diagnostic capability of the standard 12-lead electrocardiogram (ECG) with the 80-lead ECG body surface map (BSM) prehospital. Methods: Consecutive patients (n = 294) presenting prehospital with ischemic type chest pain were included. All had an ECG and BSM pretreatment and a baseline and 12-hour cardiac troponin-T or I (cTnT or cTnI). Acute MI was defined as cTnT > 0.09 or cTnI > 0.1 ng/mL. Acute MI on the BSM was defined as ST elevation measured at the J-point, ≥1mm inferior/right ventricular/high right anterior/lateral regions, ≥2 mm anterior region, ≥0.5 mm posterior region. Results: Acute MI occurred in 182/294 (62%) based on cTnT or I. ST elevation on the standard ECG predicted acute MI in 103 (sensitivity 57%, specificity 94%; c-statistic 0.73). The optimal model for the standard ECG included ST elevation, summed ST depression and past history of MI (c-statistic 0.82; Chi-square (Wald) 120.7, 3df). The BSM predicted acute MI in 146 (sensitivity 80%, specificity 92%; c-statistic 0.86). The optimal model for the BSM included BSM criteria for acute MI and past history of MI (c-statistic 0.91; Chi-square (Wald) 180.3, 2df). Conclusion: The 80-lead BSM is superior to the standard 12-lead ECG in predicting acute MI prehospital.

Although both prehospital fibrinolysis and primary angioplasty provide a clinical benefit over in-hospital fibrinolysis in acute myocardial infarction, they have not been directly compared. Our aim was to find out whether primary angioplasty was better than prehospital fibrinolysis. We did a randomised multicentre trial of 840 patients (of 1200 planned) who presented within 6 h of acute myocardial infarction with ST-segment elevation, initially managed by mobile emergency-care units. We assigned patients to prehospital fibrinolysis (n=419) with accelerated alteplase or primary angioplasty (n=421), and transferred all to a centre with access to emergency angioplasty. Our primary endpoint was a composite of death, non-fatal reinfarction, and non-fatal disabling stroke at 30 days. Analyses were by intention to treat. The median delay between onset of symptoms and treatment was 130 min in the prehospital-fibrinolysis group and 190 min (time to first balloon inflation) in the primary-angioplasty group. Rescue angioplasty was done in 26% of the patients in the fibrinolysis group. The rate of the primary endpoint was 8·2% (34 patients) in the prehospital-fibrinolysis group and 6·2% (26 patients) in the primary-angioplasty group (risk difference 1·96, 95% CI−1·53 to 5·46). 16 (3·8%) patients assigned prehospital fibrinolysis and 20 (4·8%) assigned primary angioplasty died (p=0·61). A strategy of primary angioplasty was not better than a strategy of prehospital fibrinolysis (with transfer to an interventional facility for possible rescue angioplasty) in patients presenting with early myocardial infarction.

Multimedia interventions may play an important role in improving patient care and reducing the time constraints of patient-clinician encounters. The \"MyStay Cardiac\" multimedia resource is an innovative program designed to be accessed by adult patients undergoing cardiac surgery. The purpose of this study was to evaluate the uptake of the MyStay Cardiac both during and following the COVID-19 pandemic. A prospective observational study design was used that involved the evaluation of program usage data available from the digital interface of the multimedia program. Data on usage patterns were analyzed for a 30-month period between August 2020 and January 2023. Usage patterns were compared during and following the lifting of COVID-19 pandemic restrictions. Uptake of the MyStay Cardiac was measured via the type and extent of user activity data captured by the web-based information system. Intensive care unit recovery information was the most accessed information, being viewed in approximately 7 of 10 usage sessions. Ward recovery (n=124/343, 36.2%), goal (n=114/343, 33.2%), and exercise (n=102/343, 29.7%) information were routinely accessed. Most sessions involved users exclusively viewing text-based information (n=210/343, 61.2%). However, in over one-third of sessions (n=132/342, 38.5%), users accessed video information. Most usage sessions occurred during the COVID-19 restriction phase of the study (August 2020-December 2021). Sessions in which video (P=.02, phi=0.124) and audio (P=.006, phi=0.161) media were accessed were significantly more likely to occur in the restriction phase compared to the postrestriction phase. This study found that the use of digital multimedia resources to support patient education was well received and integrated into their practice by cardiac nurses working in acute care during the COVID-19 pandemic. There was a pattern for greater usage of the MyStay Cardiac during the COVID-19 pandemic when access to the health service for nonfrontline, essential workers was limited.

Rapid advances in mobile health technologies and their ubiquitous communication capacity have invigorated remote healthcare delivery. Mobile health applications can help counter the mounting pressure on cardiac services. Patients are increasingly using health and well-being applications, including those for chronic disease monitoring. Population-screening applications are becoming widely used and can have a significant impact on early detection in future. Studies show that cardiology services are using mobile technologies to provide earlier diagnosis through remote transmission and interpretation of ECG, leading to more accurate triage and shorter door-to-balloon time in myocardial infarction. Arrhythmias can be monitored in real time, supported by automated detection algorithms, and implantable device status checks can efficiently and safely be carried out remotely. Ongoing monitoring for and early detection of deterioration in heart failure can also be achieved through mobile applications. Cardiac rehabilitation has been delivered remotely utilizing mobile technologies. Mobile health offers significant potential in providing effective, efficient and appropriately personalized care; however, further studies are required to confirm this. The objective of this review is to explore and describe studies of mobile health applications in cardiac care, including the implications for interventional cardiology, with a focus on clinical outcomes.

Background Severely destructive disasters can often lead to heavy casualties. Large arterial injury in disasters, particularly, often results in high mortality and morbidity. Although minimally invasive intervention has achieved positive effects in diagnosing and treating vascular injuries, it is still unavailable at the disaster area of any country due to lack of on-spot catheterization labs. This study aimed to test the feasibility of adopting interventional techniques to treat haemorrhage of large arterial injuries in remote and austere wild environments after severely destructive disasters, by using a new mobile intervention suite we developed—the mobile minimally invasive interventional shelter (MIS). Methods Large animal models of aortic and femoral arterial injuries were established using a newly developed medium vehicle-mounted digital subtraction angiography (DSA) machine in MIS. The endovascular stent-graft exclusion and balloon occlusion combined with surgical hemostasis were performed respectively following the protocols for rapid interventional therapy. The treatment capacity of the shelter was evaluated based on its stability, surgery duration and the clinical results. Results and discussion The stability of the medical devices in MIS directly relates to the efficiency and success rate of interventional treatment. The newly developed vehicle-mounted DSA machine showed good imaging performance and the operation of all equipments and devices in MIS were stable in interventional procedures. All the interventional treatments for large arterial injuries were performed smoothly. The average time for treating abdominal aortic injury and femoral arterial injury was 23 ± 11 and 55 ± 17 min, respectively. And the operation success rate reached 100 %. Conclusion It is feasible to perform interventional operations to control haemorrhage of large arterial injuries in MIS outside hospital. The MIS has a great potential to save patients from dying of hemorrhagic shock due to lack of effective treatment devices and approaches in remote and austere wild environments, such as in disaster areas.

Background: The accuracy of the Danish police operated \"112\" emergency call system was studied. Dispatch of the anaesthesiologist staffed mobile emergency care unit (MECU) to acute coronary syndrome (ACS) cases was used as an indicator of accuracy of dispatch to life threatening emergencies. Methods: This was an observational cohort study of patients given a 112 system report of heart attack and patients with a provisional diagnosis of ACS made on scene by the MECU. Sensitivity, specificity, and positive predictive value with 95% confidence intervals (CI) were calculated. Results: There were 341 reports of “heart attack” and 205 patients with ACS. Sensitivity was 75% (95% CI 68% to 80%) specificity 90% (89% to 92%) and positive predictive value 45% (40% to 50%). Conclusion: The accuracy of 112 dispatch of the MECU was found to be moderate. We suggest more training of dispatch staff and medical supervision.

The benefits of mobile cardiac catheterization laboratories include keeping patients closer to their families, communities, local hospitals, and primary care physicians while receiving services comparable to those available at tertiary centers. However, there are very few studies regarding the safety of performing cardiac catheterization in mobile laboratories at remote locations. Thus, the authors performed an observational study of 1,775 consecutive patients undergoing a diagnostic cardiac catheterization in a mobile catheterization laboratory at primary care hospitals served by the Appleton Heart Institute (AHI) from August 1, 1991, to December 31, 1998. Twenty-three percent (1,775/7,637) of all AHI diagnostic cases in this time period were performed in the mobile catheterization laboratory. Urgent transfer to the tertiary care facility via ambulance or helicopter was used for 2.3% of patients (n=41). The overall complication rate was 1.2% (n=21). Of the patients who underwent cardiac catheterization in the mobile laboratory, 32.6% (n=579) were subsequently referred for interventional or surgical revascularization. There were no deaths. Cardiac catheterizations can be performed safely in a mobile laboratory at primary care hospitals, provided that immediate transfer is available for those in need of urgent intervention or revascularization and that unstable patients are not studied in the mobile laboratory.

All patients brought to hospital by a special cardiac ambulance were followed up and compared with patients carried by routine ambulances to assess the effectiveness of a cardiac ambulance service. The overall mortality of patients with heart attacks was 51% among those carried by an ordinary ambulance and 40% among those carried by the cardiac ambulance. The apparently low mortality in the latter group was balanced, however, by a high mortality (68%) among patients carried by ordinary ambulances when the cardiac ambulance was available but not used; these patients tended to have a short duration of symptoms and heart attacks away from home, and their ambulance was more often called by a member of the public than a general practitioner. It seems therefore that low-risk cases were inadvertently selected for transport by the cardiac ambulance; such unintentional selection makes it difficult to evaluate a cardiac ambulance service.

The mobile coronary care unit (MCCU) as a means of reducing coronary artery disease (CAD) morbidity and mortality cannot be realized unless patients, lay others, and medical personnel use it. The initial medical care decision of 1,102 patients who experienced acute cardiac symptomatology was studied to determine factors contributing to expedient care-seeking and the decision to use emergency medical services (EMS), direct emergency room services, or physician consultation. An expedient decision to utilize the EMS, the only means of obtaining the MCCU, occurred when symptoms began suddenly and were incapacitating, lay others advised the EMS, and patients relinquished and lay others usurped control of care-seeking process. To increase MCCU utilization and effectiveness, it is suggested that public education about CAD be refined and the teaching of cardiopulmonary resuscitation expanded, physicians be encouraged to educate patients realistically as to CAD prognosis, and a cardiac crisis center be instituted that incorporates a registery for patients at high risk of myocardial infarction or sudden cardiac death.