Coronary Care Unit design, staffing and organization

Abstract

BEfore the inception of coronary care units (CCU) myocardial infarction was treated with
prolonged bed rest, digoxin and norepinephrine. Complications were frequent leading to a
high mortality rate (25-30%).
Gunnar Biorck of Stockhom wrote:
"There are few diseases in the sphere of internal medicine where the average mortality during four
to six weeks hospitalization is over 30%, and if the patients with shock are particularly considered,
the figure is more than twice as large1
”
Beck and colleagues in 1947 had resuscitated, by electric shock, a 14 year old boy in whom
ventricular fibrillation developed during operation2, 3.
Julian wrote on 5 May 1960, a 40 year old physician with a myocardial infarction collapsed on
admission to the ward. A scalpel, which was poised to incise a cubital fossa in an adjacent
catheterisation laboratory, was diverted to initiate a thoracotomy. After some minutes, help became
available from the surgeons, who performed more effective cardiac massage until internal
defibrillation could be carried out. The patient made an excellent cardiac recovery (he sustained
some cerebral damage but survived for 23years). By a curious quirk of fate he was an alumnus of
Johns Hopkins Hospital, and shortly after his recovery he showed us an article in the hospital
journal describing closed chest cardiopulmonary resuscitation, which had been developed there by
Kouwenhoven, Jude and Knickerbocker4