International Standards for a Cardiac Care Unit

A cardiac-care unit within a hospital is specially equipped to treat patients with serious heart conditions. Two types of cardiac care units exist: the intensive cardiac care unit and an intermediate cardiac care unit. Although in 2010, no single set of international standards for cardiac care units had been established, the Heart Journal published recommendations from the European Society of Cardiology Working Group on Acute Cardiac Care concerning the structure, function and organization of modern intensive and intermediate cardiac care units.

Length of Stay and Relocation

• The European Society of Cardiology Working Group on Acute Cardiac Care recommends that patients with serious cardiac conditions stay in the intensive care cardiac unit for two to four days. The group also recommends that the patient is transferred to a cardiac intermediate care unit or general ward as soon as his condition is stable. The unit should be equipped with simple electrocardiographic monitoring and run by cardiology staff. From there, the group recommends transferring the patient to an out-of-hospital recreation facility or referring him to an outpatient rehabilitation unit.

Number of Beds

• To ensure quality treatment and attention, the ESC group recommends that the amount of beds in the intensive cardiac care unit must suit the population and workload of the hospital. Measure the relative workload to the number of visits to the hospital's emergency room. For every 100,000 inhabitants, a hospital should have four to five intensive cardiac care unit beds; for every 100,000 visits per year to the ER, 10 intensive cardiac care unit beds must be provided. The intermediate cardiac care unit should have three beds for every bed in the intensive cardiac care unit.

Equipment

• The ESC group specifies that an intensive cardiac care unit ideally should be equipped with a patient monitoring unit, incorporating a cardiac catheter to monitor heart function, at least two electrocardiogram channels, an oxygen saturation meter and a noninvasive blood pressure monitor. At least half the beds in the unit should also include five electrocardiogram channels, two extra haemodynamic, or hemodynamic, channels, noninvasive cardiac output, end tidal carbon dioxide monitor, which measures the amount of carbon dioxide exhaled, and a thermometer.

  The group recommends that a nurse station should be available for central monitoring and analyzing. At least one electrocardiogram lead from every patient as well as respiratory and haemodynamic, or blood circulation, data must be shown on a central screen at all times.

  Four to six volumetric pumps or automatic syringes should be available per bed. One mechanical respirator machine has to be equipped per two beds. An intra-aortic balloon pump has to be available for every three beds. A haemodialysis machine -- which slowly pumps blood out of the body, removes waste products and extra fluid from the blood, and then pumps the filtered blood back into the circulatory system -- should be available for use. One pacemaker defibrillator must be supplied for every three beds and an external pacemaker for every six beds. Three to four single-chamber (VVI or AAI) temporary pacemakers and one dual-chamber (DDD) pacemaker for every six to eight beds must be available. The unit must have at least one mobile echocardiography machine with a transesophogeal echocardiography (TEE) probe that measures the sound waves that bounce off the heart, and one blood-clot meter. A glucose measurement kit has to be available. An X-ray unit is recommended.

  According to the Annals of Cardiac Anaesthesia, many hospitals incorporate a so-called "heart command center" in their emergency departments, with much of the equipment mentioned above to cater to cardiac emergencies. This is, however, not necessary if the cardiac care unit is situated close to the emergency room, preferably with direct ambulance access.

Beds in the Intensive Cardiac Care Unit

• The group suggests that beds in the intensive cardiac care unit should allow vertical movement, as well as up-and-down head and leg positioning. Oxygen, vacuum and compressed-air intakes must be equipped with every bed. At least one of the beds must be suitable for patients with active contagious diseases.

Staff

• At least one physician should be available to every three to four patients. The unit director should be a board certified cardiologist, who is specially trained as an acute cardiac care specialist, according to the ESC group.

Unit Construction

• The cardiac care unit should be an independent ward within the hospital. The society's working group recommends a separate room for each patient in intensive cardiac care and a maximum of three patients per room in the intermediate unit. The unit should have at least one single bedroom to isolate patients with contagious infections. A separate intensive care procedure room must be spacious enough to contain all physicians and bulky equipment necessary for treatment in a complicated case. The area should be at least 25 square meters and have washable walls of 2 meters in height. The cardiac intensive care unit ideally should be situated close to the emergency room, general intensive care unit, catheterization lab and operating theaters.

  According to a study published in the Medical Care, Issue 2, the risk of death in heart patients is significantly lower if they are admitted directly to a cardiac care unit.