coronary care unit (CCU)

A coronary care unit (CCU) is a hospital ward specialized in the care of patients cardiac conditions that require continuous monitoring and treatment.

History

The first description of a CCU was given in 1961 to the British Thoracic Society by Dr. Desmond Julian, who founded the first CCU at the Royal Infirmary of Edinburgh in 1964.

In 1967, Thomas Killip and John Kimball published a report of 250 patients with acute MI’s (myocardial infarction), who had experienced significantly better survival rates in CCUs compared to other institutions. This, along with other reports, led to an increase in coronary care units.

What Type of Patients stay on the Coronary Care Unit?

• High risk patients awaiting cardiac surgery
• PPCI patients (Primary Percutaneous Coronary Intervention)
• High risk patients with arrhythmias needing cardiac monitoring, Intravenous drugs and or/devices
•  Unstable heart failure pts. requiring invasive monitoring or intravenous medications
• High risk Acute Coronary Syndrome patients needing coronary intervention

Length of stay in the CCU

Number of beds in the CCU

The number of beds in the CCU must suit the workload of the hospital.

Recommended formula for calculation:
i. For each 100 000 inhabitants, four to five CCU beds.
ii. for every 100 000 visits per year in the internal emergency room, 10 CCU beds.

CCU equipment

i. Patient monitoring unit:
the basic patient monitoring unit must include at least two ECG channels, invasive pressure channel, non-invasive blood pressure monitor, and an SaO2 meter.

ii. Nurse station:
to be used for central monitoring and analyzing. At least one ECG lead from each patient as well as relevant hemodynamic and respiratory data should continuously be present on a central screen.

Additional equipment

• Volumetric pump/automatic syringe.
• mechanical respirators.
• hemodialysis / hemofiltration machine.
• pacemaker defibrillator.
• mobile echocardiography machine.
• blood clot metre (ACT).
• glucose level measurement kit.
• X-ray system for fluoroscopy.

CCU staff

• Department head: a certified cardiologist.
• Physicians.
• Nurses.
• Secretary.
• Technician.

CCU construction

i. The desired intensive care unit standard is a separate room for each patient and up to two to three patients per one room in the intermediate unit.

ii. There should be at least one single bedroom with the possibility to isolate patients with contagious infection.

iii. The architecture of the unit should be designed to make it possible to observe the patients from the nurses' monitoring station and to have easy and fast access.

iv. The minimal area should be 25 m2. The room must have washable walls for 2 m in height. Construction should fit requirement for the use of X-ray fluoroscopy.

v. The electrical equipment should have an emergency feeding and a continuity apparatus.

vi. A dialysis facility (source of water and sewage) should be established.

vii. The cardiac intensive care unit should be situated as close as possible to the emergency room, the catheterization lab and general intensive care unit.

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