Evolution of the concept of coronary care and the emergent role of critical care

The landscape of the CCU today, however, has changed vastly from that of the 1960s. It is no longer simply an observation unit for patients with acute MI, but rather it has become a dynamic and diverse arena of patient care. Dedicated CCU's that were developed in the 1960's have been transformed into combined units including CCU and ICU or CCU and cardiology ward with very few dedicated CCUs remaining.

The CCU has changed dramatically since its initial inception, and with it has changed the required skill set of the CCU cardiologist. It is no longer acceptable to assume that all cardiologists trained in acute cardiac care can also manage the critically ill cardiac patient. Similarly critical care medicine extended its scope to handle critically ill multi organ failure patients including emergency interventions.

As a result, now more than ever before, the distinctions between our CCUs and traditional medical ICUs have become increasingly blurred. The cardiologist is being called on to care, at the onset, for patients with multiple critical care issues.

Therefore CCU cardiologists must now be trained in the management of acute lung injury, prolonged ventilation/weaning, delirium, renal replacement therapy, gastrointestinal hemorrhage, ICU polyneuropathy, and septic shock, etc. which are skills mastered by ICU specialists.

Given the remarkable diversity of critically ill patient now seen in our CCUs, we should anticipate an imminent challenge to the general cardiologists that currently staff these units and call for dedicated intensivists to assume care for these complex patients.