Novel Frontiers in Critical-Care Cardiology: Point-of-Care Diagnostics, Evolving Systems of Care, and Contemporary Critical Care Management

Varinder Kaur Randhawa; Sean van Diepen; Benjamin Hibbert; Andre Dénault; Warwick Butt; Rakesh Arora

doi:10.1016/j.cjca.2023.02.008

Novel Frontiers in Critical-Care Cardiology: Point-of-Care Diagnostics, Evolving Systems of Care, and Contemporary Critical Care Management

Varinder Kaur Randhawa, MD, PhD
Varinder Kaur Randhawa
Correspondence
Corresponding author: Dr Varinder Kaur Randhawa, Critical Care and Heart Failure Transplant Cardiology, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, Ontario M4N 3M5, Canada.
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Affiliations
Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
Division of Cardiology, St Michael’s Hospital, Toronto, Ontario, Canada
Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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Sean van Diepen, MD, MSc
Sean van Diepen
Affiliations
Division of Cardiology, Department of Critical Care, University of Alberta, Edmonton, Alberta, Canada
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Benjamin Hibbert, MD, PhD
Benjamin Hibbert
Affiliations
Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
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Andre Dénault, MD, PhD
Andre Dénault
Affiliations
Department of Anaesthesiology, Montréal Heart Institute, Université de Montréal, Montréal, Québec, Canada
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Warwick Butt, MD
Warwick Butt
Affiliations
Intensive Care Department of Paediatrics, The Royal Childrens Hospital, Melbourne, Victoria, Australia
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Rakesh Arora, MD, PhD
Rakesh Arora
Affiliations
Harrington Heart Vascular Institute, University Hospitals and Case Western Reserve University, Cleveland, Ohio, USA
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Published:February 17, 2023DOI:https://doi.org/10.1016/j.cjca.2023.02.008

The early coronary care units (CCUs) from the 1960s have evolved over the past half century with advancements in alarm-capable monitors, point-of-care diagnostic tools, and specialised equipment to address multiorgan dysfunction for patients presenting with more complex cardiovascular disease and both cardiac and noncardiac intensive care unit (ICU)–related needs.

¹

le May M.
van Diepan S.
Liszkowski M.
et al.

From coronary care units to cardiac intensive care units: recommendations for organisational, staffing, and educational transformation.

By the 2000s, the advent of CCUs and protocolised cardiovascular care delivered by establishing systems-of-care and referral networks had shifted the demographics and scope of management of the critically ill patients with cardiovascular disease admitted to contemporary cardiac (CICUs) and cardiovascular (CVICUs) intensive care units.

¹

le May M.
van Diepan S.
Liszkowski M.
et al.

From coronary care units to cardiac intensive care units: recommendations for organisational, staffing, and educational transformation.

^,

²

Katz J.N.
Shah B.R.
Volz E.M.
et al.

Evolution of the coronary care unit: clinical characteristics and temporal trends in healthcare delivery and outcomes.

For example, more patients with acute myocardial infarction (AMI) are dying of ventricular failure rather than fatal arrhythmias, owing to timely defibrillation, transvenous pacers, thrombolysis, primary percutaneous coronary intervention, and therapeutic hypothermia delivered within regional systems of care.

¹

le May M.
van Diepan S.
Liszkowski M.
et al.

From coronary care units to cardiac intensive care units: recommendations for organisational, staffing, and educational transformation.

Currently, patients with end-stage cardiomyopathies complicated by cardiogenic shock (CS) can be bridged to mechanical heart pumps and heart transplantation with the use of vasoactive agents along with temporary mechanical circulatory (tMCS), renal, and ventilatory support devices.

¹

le May M.
van Diepan S.
Liszkowski M.
et al.

From coronary care units to cardiac intensive care units: recommendations for organisational, staffing, and educational transformation.

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Published online: February 17, 2023

Accepted: February 10, 2023

Received: February 9, 2023

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DOI: https://doi.org/10.1016/j.cjca.2023.02.008

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Novel Frontiers in Critical-Care Cardiology: Point-of-Care Diagnostics, Evolving Systems of Care, and Contemporary Critical Care Management

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