Coronary Care Unit to Cardiac Intensive Care Unit: Acute Medical Cardiac Care—Adapting With the Times

Acute medical cardiac care in Canada has traditionally been provided in various coronary care unit (CCU) settings. Current needs and practice in the case of the medical patients with cardiac disease are better reflected in the concept of a cardiac intensive care unit (CICU). The original concept of a CCU was described in 1961 by both Wilburne and Julian as a care program targeting a special group of patients with acute myocardial infarction (AMI), aiming to recognize and treat life-threatening arrhythmias. This focus was more specific than the intensive care model of the time, in which patients received care for a broad range of medical and surgical problems. Implementation of the CCU concept occurred over the next 10 years. It was recognized early on that many lives were saved and that this model also empowered nurses to have an active role in the care of these patients because they were trained to defibrillate patients in a timely manner. The CCU model importantly enabled further understanding of the pathophysiology of AMI, the importance of controlled clinical trials, and eventually the development of early reperfusion strategies: surgery, thrombolysis, and percutaneous intervention, and, more recently, implementation of time-sensitive ST-elevation myocardial infarction (STEMI) algorithms. CCU organization has varied, depending on the type of institution and the physical and medical resources available and may include dedicated or shared units. The cardiac care itself may range from basic support to the most sophisticated cardiac care, including mechanical circulatory assistance in its various forms. Depending on need, such acutely ill patients are usually triaged to the most suitable regional CCU setting and in as timely a manner as possible. In 2016, CCUs deliver increasingly complex care, requiring expanded levels of expertise for both cardiac and noncardiac problems. CCU patients have various cardiac