Authors

• Renata Čosić — Klinički bolnički centar Sestre milosrdnice, Zagreb, Hrvatska — ORCID: 0000-0001-6508-7432
• Mihaela Ipša — Klinički bolnički centar Sestre milosrdnice, Zagreb, Hrvatska — ORCID: 0000-0002-4305-1524
• Katarina Arbanas — Klinički bolnički centar Sestre milosrdnice, Zagreb, Hrvatska — ORCID: 0000-0003-1639-916X
• Tamara Kožić — Klinički bolnički centar Sestre milosrdnice, Zagreb, Hrvatska — ORCID: 0000-0001-5522-865X
• Zdravko Babić — Klinički bolnički centar Sestre milosrdnice, Zagreb, Hrvatska — ORCID: 0000-0002-7060-8375

Abstract

The first coronary units were founded in the 1960s with the goal of ensuring optimal cardiopulmonary reanimation in patients with myocardial infarction. The Cardiac Care Unit at the University Hospital Centre “Sestre milosrdnice” was founded on September 23, 1970 and was the first and oldest intensive care unit for cardiological patients in southeastern Europe. Over the next several decades it developed in line with global trends and grew into the Department for Intensive Cardiac Care with ten intensive care beds, ensuring comprehensive intensive cardiological care. The team of nurses and physicians cares for approximately 1600 patients annually with an average hospital stay of 2.2 days, which puts us in line with European averages. Since 2005 we have been a part of the Croatian Network for Interventional Treatment of Acute Myocardial Infarction and have managed patients from parts of the City of Zagreb and Zagreb County as well as the Sisak-Moslavina County and the Karlovac County. Healthcare and treatment provided by our team of health professionals are facilitated by the sophisticated medical devices with which the institute is equipped.

Keywords

intensive cardiac care, medical team, organization

DOI

Full Text

Cardiovascular diseases represent the leading cause of mortality in modern humans, among which the largest group of patients is composed of those suffering from acute coronary syndrome. The necessity of introducing specific intensive care units that would provide specialized care for cardiological patients was recognized as early as the 1960, and the primary goal was to ensure optimal cardiopulmonary reanimation for patients at the acute stage of myocardial infarction. The first description of coronary care units (CCU) in the word was published in 1961 in the British Thoracic Society journal, and the units were located in the cities of Sydney, Kansas City, Philadelphia, London, and Edinburgh. (1-4) Nine years later, the CCU at the University Hospital Centre (UHC) “Sestre milosrdnice” was founded on September 23, 1970 as the first and oldest intensive care unit for cardiological patients in southeastern Europe. It had four intensive care beds with the requisite monitoring systems. In June 1989 the CCU moved to a new location and increased its capacity to eight intensive care beds. Since 2005 we have been a part of the Croatian Network for Interventional Treatment of Acute Myocardial Infarction and have managed patients from parts of the City of Zagreb and Zagreb County as well as the Sisak-Moslavina County and the Karlovac County. On October 1, 2015 the Department for Cardiovascular Diseases became an independent Clinic for Cardiovascular Diseases of the UHC “Sestre milosrdnice”, separating from the Clinic for Internal Diseases. The Cardiac Care unit became the Department for Intensive Cardiological Care in 2016. Today the department has ten intensive care beds of which four are have hospital boxes where patient isolation can be performed if necessary or specific interventions are required, such as hypothermia, extracorporeal membrane oxygenation (ECMO), etc. (4-8) Patients are cared for by a team of 20 nurses, three cardiologists, and a varying number of younger residents. Nurses work the morning shift and two 12-hour shift (12-24-12-48), whereas physicians work the morning shift and 24-hour shifts and call duty (**Figure 1**). Approximately 1600 patients are admitted annually, and the average hospital stay is 2.2 days (**Figure 2**), placing us in line with the European average. FIGURE 1. Represents increasing number of patient admissions to the Intensive Cardiac Care Department in relation to number of nurses taking care of them, cardiology specialists treating them and available hospital beds from 1989 to 2018. FIGURE 2. Represents the number of admissions in relation to the average stay. The total number of admissions for 2018 was 1613 patients. The average stay for 2018 was 2.2 days. Providing high-quality healthcare and treatment for patients is facilitated by the sophisticated medical devices with which the department is equipped. These include central and individual monitoring of heart function and other vital functions, defibrillators, an echocardiography device, an ECG device, ECMO and intra-aortic balloon pump (IABP), mechanical ventilation devices, temporary pacemakers, a system for invasive pressure measurement, a point-of-care blood testing device, infusion pumps, aspirators, and reanimation carts. Various non-invasive and invasive diagnostic and treatment procedures are performed during patient hospitalization. We perform continuous heart function monitoring, emergency pericardiocentesis with echocardiographic monitoring, hypothermia treatment, ECMO, IABP support, invasive and non-invasive mechanical ventilation, percutaneous and temporary pacemaker treatment, percutaneous tracheotomy, central venous catheter implantation, pleural and abdominal punction, and continuous veno-venous hemofiltration (**Figure 3**, **Figure 4**). (9, 10) FIGURE 3. Represents the number of percutaneous coronary intervention (PCI) procedures with separated percutaneous transluminal coronary angioplasty and stent numbers. In the first half of 2019 there were about half as much PCI procedures compared with 2018. PCI = percutaneous coronary intervention; PTCA = percutaneous transluminal coronary angioplasty. FIGURE 4. Represents the number of all the procedures done in Intensive Cardiac Care Unit (ICCU) throughout 2018 and the first half of 2019. Central venous catheters and ventilators take the lead as the most common procedures in our ICCU, followed by non-invasive ventilation in third place. CVC = central venous catheter; NIV = noninvasive ventilation; ECMO = extracorporeal membrane oxygenation; CVVHDF = continuous veno-venous hemodiafiltartion; CPR = cardiopulmonary resuscitation. Nurses work in continuous 24-hour sifts to provide care and treatment for patients and improve its quality within their fields of competence, while also participating in conducting nursing and medical nurse interventions, administering nursing documentation and using the lists of Croatian Chamber of Nurses in both written and electronic forms, providing psychological support to the patients and their families, initiating patient education focused on the effects and possible changes in risk factors, lifestyle habits, and quality of life for patients suffering from cardiovascular diseases, and constantly participating in various forms of education by attending lectures, courses, cardiological conferences, and congresses and developing their skills and competencies. In order to satisfy the needs of patients to the highest degree and follow advancements in medicine and nursing, they also acquire knowledge, skills, and competencies necessary for safe and effective work and healthcare. ## Conclusion The introduction of coronary care units and their development into intensive cardiology care units as well as the introduction of modern diagnostic and treatment options have contributed to improving treatment outcomes for the most severe cases of cardiological diseases. The efficacy and quality of care for such patients requires continuous, life-long education on part of the whole cardiological team. The role of nurses specialized in working at such institutes as necessary and equal members of the medical team is invaluable in achieving the optimal results.

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