Two New Ways to Help a Patient Survive a Heart Attack

The first few hours and days after a heart attack are the hardest. Even among patients admitted promptly to some of the world's best hospitals, the first-week death rate runs to 20% or 30%. To improve this depressing record, British doctors are testing two innovations in patient care.

Long, Light Sleep. At London's Charing Cross Hospital, a team led by Dr. Peter Nixon relies on sleep to ease the coronary occlusion victim through the first dangerous days. Their reasoning: pain and fear may be important factors in throwing a weakened, damaged heart into fatal arrest. They give their patients two sedative drugs, promethazine and pethidine (a synthetic equivalent of morphine), to keep them in a light sleep for one to seven days; the average has been 2½ days. Nurses wake the patient three times a day for hygiene, to take liquid food, and to do leg exercises designed to prevent clot formation.

The Nixon team reports in the Lancet that of 59 patients treated, one died from perforation of a peptic ulcer. After their treatment, eight more died, but most of these had complicating diseases or injuries.

Like a Sub. Only a mile away at Westminster Hospital, high-pressure oxygen is producing impressive results for Dr. Richard Ashfield's coronary patients. To administer oxygen under pressure, Dr. Ashfield helped to design a device that looks like a minature submarine with a bubble top. Inside it, the patient lies on a foam-rubber bed or can lean half upright against a back rest. The lid is tightly shut by a series of strong sealing locks around the rim.

The patient's electrocardiogram is monitored continuously on an oscilloscope; handy dials show when the pressure in the tank has reached the desired two atmospheres.

Dr. Ashfield reasons that victims of severe heart attacks not only feel and appear breathless--they are actually oxygen-starved because neither heart nor lungs are working efficiently. For his tests he has chosen only patients who have had severe, potentially fatal heart attacks. He puts them in the chamber for a minimum of four days (one man stayed in for ten days). The patient breathes pure oxygen under pressure for two hours; then the lid is opened, and he breathes ordinary air for one hour. This cycle is repeated around the clock. Of Ashfield's first 40 patients, only three have died during treatment and two turned out to have had both major coronary arteries blocked. These two were among twelve who were in cardiogenic shock (almost complete circulatory collapse), a condition that carries a forbidding mortality of 80% or more. But all ten others, even in this worst-risk group, survived.

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