Coronary care unit
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Overview
A coronary care unit (CCU) is an area of a hospital specialized in the care of patients who are critically ill with heart disease. The CCU is a subset or subtype of intensive care unit (ICU) care. The role of the coronary care unit (CCU) varies tremendously between hospital centers. In small rural centers, any patient who is being “ruled out” for a myocardial infarction (MI) may be placed in a CCU. In contrast, in large urban teaching hospitals, only those patients requiring invasive hemodynamic monitoring with a pulmonary artery catheter, mechanical ventilation, and intraaortic balloon pump (IABP) counterpulsation may be placed in the CCU. Many hospitals contain both a CCU for critically ill patients and units called either an "intermediate care unit", "progressive care unit", "telemetry floor" or "step down unit" for patients who are not as crtically ill. These units provide a level of care that is 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. In those hopsitals who provide cardiothoracic surgery services, there is often a coronary care unit dedicated to the management of patients following coronary artery bypss grafting (CABG), aortic valve surgery or other thoracic surgery.
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.
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 and Philadelphia. Studies published in 1967 revealed that those observed in a coronary care setting had consistently better outcomes (Mehta & Khan 2002).[1]
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