Ameesh Isath MBBS , Atul Bali MD , Uzair A. Mahmood MD , David D. Berg MD, MPH , Vivian M. Baird-Zars MPH , Erin A. Bohula MD, DPhil , Lori B. Daniels MD, MAS , Mark Dodson MD, PhD , Jason N. Katz MD, MHS , Younghoon Kwon MD, MS , Daniel Loriaux MD , Srini Mukundan MD , L. Kristin Newby MD, MHS , Jeong-Gun Park PhD , Mitchell Padkins MD , Rajnish Prasad MD , Michael A. Solomon MD, MBA , Sammy Zakaria MD, MPH , David A. Morrow MD, MPH , Howard A. Cooper MD
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Cooper MD","doi":"10.1016/j.jacadv.2025.102048","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><div>Cardiac intensive care units (CICUs) typically manage critically ill patients with acute cardiovascular (CV) conditions but may serve patients with non-CV critical illness when medical ICU (MICU) beds are unavailable.</div></div><div><h3>Objectives</h3><div>The purpose of this study was to characterize the clinical profiles and outcomes of “MICU overflow” admissions to the CICU.</div></div><div><h3>Methods</h3><div>We used the Critical Care Cardiology Trials Network registry to compare CICU admissions without acute or major cardiac issues (MICU overflow) vs those with acute CV illness.</div></div><div><h3>Results</h3><div>Among 19,912 CICU admissions (2018-2023), 923 (4.6%) were MICU overflow, ranging from 0% to 26% across centers. MICU overflow admissions had higher median Sequential Organ Failure Assessment scores than CV admissions (5 vs 3; <em>P</em> < 0.001) and more commonly presented with respiratory failure (50.5% vs 24.6%; <em>P</em> < 0.001) and noncardiogenic shock (30.9% vs 8.0%; <em>P</em> < 0.001). MICU overflow status was associated with similar ICU mortality (adjusted OR: 1.13; 95% CI: 0.90-1.43; <em>P</em> = 0.28) but higher hospital mortality (adjusted OR: 1.80; 95% CI: 1.48-2.19; <em>P</em> < 0.001) vs CV illness. In units where the CICU team managed all admissions, ICU mortality was higher among MICU overflow admissions than CV admissions (adjusted OR: 1.35; 95% CI: 1.02-1.80; <em>P</em> = 0.04), whereas in CICUs where off-unit MICU teams managed MICU overflow admissions, this mortality imbalance was not present (adjusted OR: 0.72; 95% CI: 0.47-1.11; <em>P</em> = 0.14; <em>P</em> interaction = 0.02).</div></div><div><h3>Conclusions</h3><div>MICU overflow admissions constitute a meaningful proportion of the CICU population and present with more multisystem disease and experience higher hospital mortality compared with acute CV admissions, underscoring the need for multidisciplinary CICU teams with broad critical care expertise.</div></div>","PeriodicalId":73527,"journal":{"name":"JACC advances","volume":"4 10","pages":"Article 102048"},"PeriodicalIF":0.0000,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Medical Intensive Care Unit Overflow Into the Cardiac Intensive Care Unit\",\"authors\":\"Ameesh Isath MBBS , Atul Bali MD , Uzair A. 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MICU overflow admissions had higher median Sequential Organ Failure Assessment scores than CV admissions (5 vs 3; <em>P</em> < 0.001) and more commonly presented with respiratory failure (50.5% vs 24.6%; <em>P</em> < 0.001) and noncardiogenic shock (30.9% vs 8.0%; <em>P</em> < 0.001). MICU overflow status was associated with similar ICU mortality (adjusted OR: 1.13; 95% CI: 0.90-1.43; <em>P</em> = 0.28) but higher hospital mortality (adjusted OR: 1.80; 95% CI: 1.48-2.19; <em>P</em> < 0.001) vs CV illness. 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引用次数: 0
摘要
背景：心脏重症监护室（CICUs）通常用于治疗急性心血管（CV）疾病的危重患者，但在没有医疗ICU （MICU）床位的情况下，也可以服务于非CV危重疾病的患者。目的：本研究的目的是描述CICU“MICU溢出”入院的临床概况和结果。方法：我们使用重症心脏病学试验网络注册来比较没有急性或主要心脏问题（MICU溢出）的CICU入院与急性心血管疾病的患者。结果：在2018-2023年的19912例CICU入院患者中，923例（4.6%）发生MICU溢出，各中心的发生率从0%到26%不等。MICU溢位入院患者序贯器官衰竭评估评分中位数高于CV入院患者（5比3，P < 0.001），更常见的是呼吸衰竭（50.5%比24.6%,P < 0.001）和非心源性休克（30.9%比8.0%,P < 0.001）。MICU溢出状态与相似的ICU死亡率（校正OR: 1.13; 95% CI: 0.90-1.43; P = 0.28）相关，但与CV疾病相比，住院死亡率更高（校正OR: 1.80; 95% CI: 1.48-2.19; P < 0.001）。在CICU团队管理所有住院患者的单位中，MICU溢出入院的ICU死亡率高于CV入院（调整后的OR: 1.35; 95% CI: 1.02-1.80; P = 0.04），而在非单位MICU团队管理MICU溢出入院的CICU中，这种死亡率失衡不存在（调整后的OR: 0.72; 95% CI: 0.47-1.11; P = 0.14； P交互作用= 0.02）。结论：与急性CV入院患者相比，MICU溢位入院患者在CICU人群中占相当大的比例，并且存在更多的多系统疾病，并且具有更高的医院死亡率，这强调了对具有广泛重症监护专业知识的多学科CICU团队的需求。
Medical Intensive Care Unit Overflow Into the Cardiac Intensive Care Unit
Background
Cardiac intensive care units (CICUs) typically manage critically ill patients with acute cardiovascular (CV) conditions but may serve patients with non-CV critical illness when medical ICU (MICU) beds are unavailable.
Objectives
The purpose of this study was to characterize the clinical profiles and outcomes of “MICU overflow” admissions to the CICU.
Methods
We used the Critical Care Cardiology Trials Network registry to compare CICU admissions without acute or major cardiac issues (MICU overflow) vs those with acute CV illness.
Results
Among 19,912 CICU admissions (2018-2023), 923 (4.6%) were MICU overflow, ranging from 0% to 26% across centers. MICU overflow admissions had higher median Sequential Organ Failure Assessment scores than CV admissions (5 vs 3; P < 0.001) and more commonly presented with respiratory failure (50.5% vs 24.6%; P < 0.001) and noncardiogenic shock (30.9% vs 8.0%; P < 0.001). MICU overflow status was associated with similar ICU mortality (adjusted OR: 1.13; 95% CI: 0.90-1.43; P = 0.28) but higher hospital mortality (adjusted OR: 1.80; 95% CI: 1.48-2.19; P < 0.001) vs CV illness. In units where the CICU team managed all admissions, ICU mortality was higher among MICU overflow admissions than CV admissions (adjusted OR: 1.35; 95% CI: 1.02-1.80; P = 0.04), whereas in CICUs where off-unit MICU teams managed MICU overflow admissions, this mortality imbalance was not present (adjusted OR: 0.72; 95% CI: 0.47-1.11; P = 0.14; P interaction = 0.02).
Conclusions
MICU overflow admissions constitute a meaningful proportion of the CICU population and present with more multisystem disease and experience higher hospital mortality compared with acute CV admissions, underscoring the need for multidisciplinary CICU teams with broad critical care expertise.
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