Resuscitating a Circulation Abstract to Celebrate the 50th Anniversary of the Coronary Care Unit Concept

Eugene Braunwald, a world leader in cardiology for more than half a century, considers the coronary care unit (CCU) “the single most important advance in the treatment of acute myocardial infarction” (AMI).1 The first description of the CCU concept published in North America appeared in Circulation in October 1961. Los Angeles cardiologist Morris Wilburne outlined a technology-inspired extension of the intensive care unit model that had been developed during the previous decade.2 There was 1 crucial difference, however. The intensive care unit was a place to care for acutely ill patients with a broad range of surgical and medical problems. On the other hand, the CCU was conceived as a program of care that targeted a specific group of patients: those at risk of sudden death in the context of an AMI. Vulnerable patients were admitted to a special space staffed by nurses trained to use new electronic technologies for the rapid diagnosis and treatment of life-threatening arrhythmias and to perform cardiopulmonary resuscitation (CPR).The advent and diffusion of the CCU transformed the care of patients, the careers of cardiologists, and the boundaries of nursing practice in less than a decade. Continuous ECG monitoring alerted the staff to a life-threatening arrhythmia. This innovation was coupled with 3 new closed-chest treatment technologies: defibrillators, pacemakers, and CPR. The successful treatment of ventricular fibrillation (VF), an arrhythmia that had been invariably fatal, provided compelling evidence that the CCU model saved lives. Cardiac arrest caused irreversible brain damage in <4 minutes, so there was no time to wait for a doctor to rush to a patient and discharge a defibrillator. To address this problem, physicians trained specific nurses to deliver a life-saving shock without personal supervision. The first CCUs were opened in 1962. During the next decade, defibrillation was supplemented by new …