Coronary care unit

A coronary care unit (CCU) is a hospital ward specialized in the care of patients with heart attacks, unstable angina, Cardiac dysrhythmia and (in practice) various other cardiac conditions that require continuous monitoring and treatment.

Characteristics

The main feature of coronary care is the availability of telemetry or the continuous monitoring of the cardiac rhythm by electrocardiography. This allows early intervention with medication, cardioversion or defibrillation, improving the prognosis. As arrhythmias are relatively common in this group, patients with myocardial infarction or unstable angina are routinely admitted to the coronary care unit. For other indications, such as atrial fibrillation, a specific indication is generally necessary, while for others, such as heart block, coronary care unit admission is standard.

Local differences

In the United States, coronary care units are usually subsets of intensive care units (ICU) dedicated to the care of critically ill cardiac patients. These units are usually present in hospitals that routinely engage in cardiothoracic surgery. Invasive monitoring such as with pulmonary artery catheters is common, as are supportive modalities such as mechanical ventilation and intra-aortic balloon pumps (IABP).

Certain hospitals, such as Johns Hopkins [1], maintain mixed units consisting of both Acute care units for the critically ill, and intermediate care units for patients who are not critical.

Acute coronary care

Acute coronary care units (ACCU), also called "critical coronary care units" (CCCU) is equivalent to intensive care in the level of service provided. Patients with acute myocardial infarction, cardiogenic shock, or post-operative "open-heart" patients commonly abide here.

Subacute coronary care

Subacute coronary care units (SCCU), also called Progressive care units (PCU), Intermediate coronary care units (ICCU), or stepdown units, and provide a level of care intermediate to that of the intensive care unit and that of the general medical floor. These units typically serve patients who require cardiac telemetry such as those with unstable angina.

History

Coronary care units developed in the 1960s when it became clear that close monitoring by specially trained staff, cardiopulmonary resuscitation and medical measures could reduce the mortality from complications of cardiovascular disease. The first description of a CCU was given in 1961 to the British Thoracic Society, and early CCUs were located in Sydney, Kansas City and Philadelphia. Studies published in 1967 revealed that those observed in a coronary care setting had consistently better outcomes.^[1] The first coronary care unit was opened at Bethany Medical Center in Kansas City, Kansas by Dr Hugh Day, and he coined the term.^[2][3] Bethany Medical Center is also where the first "crash carts" were developed.^[4]

References

1. ^ Mehta NJ, Khan IA (2002). "Cardiology's 10 greatest discoveries of the 20th century". Tex Heart Inst J 29 (3): 164–71. PMC 124754. PMID 12224718. http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=124754. 
2. ^ Day HW (April 1962). "A cardiac resuscitation program". J Lancet 82: 153–6. PMID 13884060. 
3. ^ Julian DG (September 2001). "The evolution of the coronary care unit". Cardiovasc. Res. 51 (4): 621–4. doi:10.1016/S0008-6363(01)00365-0. PMID 11530092. http://cardiovascres.oxfordjournals.org/cgi/content/full/51/4/621. 
4. ^ Unplugged: Reclaiming Our Right to Die in America, William H. Colby