Editor’s Choice - Acute Cardiovascular Care Association Position Paper on Intensive Cardiovascular Care Units: An update on their definition, structure, organisation and function

Abstract

Acute cardiovascular care has progressed considerably since the last position paper was published 10 years ago. It is now a well-defined, complex field with demanding multidisciplinary teamworking. The Acute Cardiovascular Care Association has provided this update of the 2005 position paper on acute cardiovascular care organisation, using a multinational working group. The patient population has changed, and intensive cardiovascular care units now manage a large range of conditions from those simply requiring specialised monitoring, to critical cardiovascular diseases with associated multi-organ failure. To describe better intensive cardiovascular care units case mix, acuity of care has been divided into three levels, and then defining intensive cardiovascular care unit functional organisation. For each level of intensive cardiovascular care unit, this document presents the aims of the units, the recommended management structure, the optimal number of staff, the need for specially trained cardiologists and cardiovascular nurses, the desired equipment and architecture, and the interaction with other departments in the hospital and other intensive cardiovascular care units in the region/area. This update emphasises cardiologist training, referring to the recently updated Acute Cardiovascular Care Association core curriculum on acute cardiovascular care. The training of nurses in acute cardiovascular care is additionally addressed. Intensive cardiovascular care unit expertise is not limited to within the unit's geographical boundaries, extending to different specialties and subspecialties of cardiology and other specialties in order to optimally manage the wide scope of acute cardiovascular conditions in frequently highly complex patients. This position paper therefore addresses the need for the inclusion of acute cardiac care and intensive cardiovascular care units within a hospital network, linking university medical centres, large community hospitals, and smaller hospitals with more limited capabilities.

Demographics, Care Patterns, and Outcomes of Patients Admitted to Cardiac Intensive Care Units

“…6 In light of such changes, expert groups from international professional societies have identified a need for CICUs to adapt to this transformation of cardiac critical care and called for additional research to quantitatively characterize the demographics, diagnoses, therapies, technology, and outcomes in contemporary CICUs to aid in directing such redesigns. 1,7,8 Additionally, experts have identified gaps in the evidence guiding the organization of CICUs as well as the management of the highly morbid conditions encountered in these units. 1,9,10 Despite the substantial resource consumption and heightened risk of many conditions requiring CICU care, to our knowledge, there are few highquality prospective studies and randomized clinical trials to guide practice in this environment.…”

Intra‐aortic balloon pump: is the technique really outdated?

“…ECMO may offer an appealing support as this technique proved its efficacy in CS, 7 especially in the case of biventricular dysfunction. However, ECMO is available only in selected “level 3” centres, 8 limiting its utilization in routine. In our study, ECMO utilization mainly increased in large centres with cardiac surgery that may correspond to those “level 3” centres.…”

Design and preliminary results of FRENSHOCK 2016: A prospective nationwide multicentre registry on cardiogenic shock

“…Furthermore, this study showed an increase in the prevalence of CS in intensive care (from 4.1% to 7.7% between 1997 and 2012) [22], and persistence of a high mortality rate, advocating further specific research [13,16,22]. Moreover, little is known about networks dedicated to CS, despite the fact that they could play a major role in the management of these patients [23].…”