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

摘要

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 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.1,2 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 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.