Evolution of Critical Care Cardiology: Transformation of the Cardiovascular Intensive Care Unit and the Emerging Need for New Medical Staffing and Training Models: A Scientific Statement From the American Heart Association
The following are 10 points to remember about this scientific statement:
1. Critical care, defined as the diagnosis and management of life-threatening conditions that require close or constant attention by a group of specially trained health professionals, is inherent to the practice of cardiovascular medicine.
2. The contemporary cardiac intensive care unit (CICU) is no longer merely a ‘coronary’ observation unit for peri-infarction complications, but has become an ICU for complex patients with cardiovascular disease who become critically ill and who are more prone to major systemic complications, including renal failure, respiratory failure, thrombosis, bleeding, catheter-related infections, ventilator-acquired pneumonia, and multiorgan dysfunction.
3. Coincident with significant increases in noncardiovascular critical illnesses, the use of advanced supportive technologies, both cardiovascular and noncardiovascular, has increased and requires specialized expertise that is not in the realm of common experience for the general clinical cardiologist.
4. The transformation of the CICU necessitates innovative approaches to the staffing, structure, and training behind the contemporary CICU. Evidence-based staffing models that are adaptable to the variety of clinical settings in which cardiovascular care is provided and adhere to the tenet that the availability of experienced cardiac intensivists, either as primary caregivers or as consultants, is central to the optimal delivery of advanced cardiac critical care.
5. The primary responsibility for management of patients whose dominant medical problem is cardiovascular should reside with a clinician with advanced skills in cardiovascular disease.
6. Specialized critical care nurses are essential to high-quality ICU care as is a multidisciplinary team consisting of a cardiovascular pharmacist, dietician, physical therapist, and social worker.
7. Available evidence supports a closed structure staffed by dedicated cardiac intensivists as a preferred approach for the level 1 (highest level) CICU.
8. Successful implementation of such models will require the development of new pathways for training of cardiologists with advanced skills in critical care cardiology.
9. The future of cardiovascular critical care medicine is rapidly evolving, with an opportunity to improve the education and skills of clinicians and the care of their patients.
10. With an increasing proportion of health care dollars going into care during the last months of life, much of this in ICUs, research into efficient use of resources is also warranted.
Keywords: Pharmacists, Intensive Care Units, Coronary Care Units, Physical Therapists, Cardiovascular Diseases, Consultants, Critical Care, Nurses, Caregivers
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