The second Coronary Care Unit (CCU) in the Republic of Croatia was founded in April 1971 within the Internal Medicine Department (just nine years after the first such unit was opened globally). Chief Physician Dr Josip Vuletić, who was also the vice-president of the Croatian Cardiac Society for many years, was the unit’s head and the head of the cardiology department that developed from that initial basis. Between 1991 and 2001 the department was led by Chief Physician Dr Josip Halle, between 2001 and 2003 by Prof Dr Roman Urek, PhD, and between 2003 and 2011 the institute director was Prof Dr Jure Mirat, PhD. Since 2011 the institute was directed by Assist Prof Dr Jozica Šikić, PhD, the president of the Working Group for Valvular Diseases of the Croatian Cardiac Society.

In 2003/2004 the Institute for Cardiovascular Diseases was fully renovated and restructured as part of a priority project at the level of the Republic of Croatia. The unit for intensive treatment of cardiological patients received modern equipment, as did the angiography hall for heart catheterization and performance of interventional procedures (percutaneous coronary interventions with stent implantation).

The unit for intensive treatment of cardiological patients cares for patients with the most severe life-threatening conditions resulting from myocardial infarction, malignant arrhythmias, and acute and chronic heart failure in the acutization phase. A program was introduced in 2011 for heart transplants in patients with chronic heart failure, which includes pre-transplant processing and post-transplant monitoring and treatment. In addition to the transplantation program, the treatment of chronic heart failure employs the most advanced mechanical pumps to support the left ventricle (Heart Mate II and III).

The Institute for Cardiovascular Diseases (Figure 1) is an educational base for the University of Zagreb Medical School and the Josip Juraj Strossmayer University Medical School in Osijek.

The Department for Intensive Cardiological Treatment and Arrhythmias

The Department for Intensive Cardiological Treatment and Arrhythmias (Figure 2) is an organizational subunit under the Institute for Cardiovascular Diseases of the Sveti Duh Clinical Hospital (CH) that provides 24-hour life support, emergency medical treatment, reanimation at the level of advanced life support, intensive treatment, continuous hemodynamic invasive and non-invasive monitoring and constant supervision, and high-quality healthcare.

The Department for Intensive Cardiological Treatment and Arrhythmias has 6 bed units available. Every bed allows the provision of the highest level of intensive care.

The CCU (Figure 3) admits and treats patients in life-threatening critical conditions with severe loss of one or more vital functions, and must therefore provide intensive treatment, monitoring, and care for such life-threatening conditions.

The department head is Prof Dr Goran Miličević, PhD, and the head nurse is Tomislav Maričić, BN.

The Department has 15 employees: 2 male nurses with a master’s degree in nursing, 4 female nurses with master’s degree in nursing, and 9 nurses with vocational nursing school of which currently only one is attending a nursing course at a university of healthcare sciences. The average employee age is 31 years.

Two nurses work per shift (based on the “12-24-12-48” principle), and the morning shift (07-15h) also includes the head nurse or one additional nurse with vocational school education.

The central monitoring unit – all monitors are networked and connected with the central monitoring unit at the nurse desk, where patient vital functions are monitored 24 hours per day. The central monitoring unit consists of a central server, a PC, 1 monitor, and a printer to print data on rhythm dysfunction. Every disorder or deviation is registered and stored by the monitoring center, and the archive of alarms and other data can be accessed at any time.

In case of heart rhythm disorder, cardiac arrest, or some other deviation from previously defined standard values the monitor will provide a auditory and visual warning to the team of nurses and automatically present one or more of the previously established ECG leads and other data such as: bed number and patient name, date and time, ECG interpretation and pulse value, the emergence and number of ventricular extrasystoles, blood pressure, and other monitored parameters that have been assigned.

Nurses are responsible for the parameters – alarm values, and it is also their duty to adjust the alarm values to the specific needs of the patient upon admission. For instance, this includes determining the values at which the monitor will produce an alarm for bradycardia, tachycardia, hypertonia and hypotonia, oxygen saturation loss, increase or drop in temperature, and for other parameters monitored in individual patients.

All monitor alarms must be on during the entire duration of a patient’s stay at the CCU because they otherwise cannot fulfil their purpose, i.e. a possible disorder may not be observed in time which may lead to a lethal outcome for the patient.

Ever alarm by the central monitor must be addressed seriously by the nurses: they must go to the patient, turn off the alarm, check the condition of the patient, determine the reason for the alarm, resolve the cause of the alarm (if it is within the domain of nurse duties or call a physician if it is not), reset the alarm, alert a physician if needed, and if necessary start cardiopulmonary reanimation measures.

Cardiopulmonary reanimation (CPR) at the University Hospital “Sveti Duh” Coronary Care Unit is performed according to the algorithm for advanced life support of the European Resuscitation Council (ERC) with adherence to ethical and moral principles. Nurses at the CCU independently start and perform the CPR procedure until the arrival of the on-call physician and anesthesiologist if they are required, and continue to provide CPR as part of the team after their arrival. The most common cause of CPR initiation at the CCU are bradycardia and asystole (with or without P-wave presence) followed by ventricular fibrillation (VF) and pulseless ventricular tachycardia (VT), which manifest in patients with previous cardiac issues or in patients with serious electrolyte disbalance.

Some of the procedures nurses are educated in:

The coronary unit is equipped with one reanimation cart placed in a designated location. The reanimation cart is equipped with a defibrillator that includes monitoring cables, ECG electrodes for continuous heart action monitoring, electroconductive gel, and self-adhesive leads (for pacing, monitoring and defibrillation).

The equipment (Figure 4) at the Department consists of: 6 Nihon Kohden monitors connected to a central monitoring system, a 12-lead ECG device, 6 infusion pumps, 6 perfusion pumps, 2 non-invasive ventilators, a bispectral index (BIS) device, an inhaler, a portable ultrasound device (cardiological and vascular probe), 4 batteries for temporary electrical heart stimulation, 6 aspirators, a medication cart, an invasive procedures cart, a treatment preparation cart, and a patient healthcare cart.

Department statistics are shown in Table 1.

The Coronary Care Unit tomorrow – education of personnel, synchronization, and working together to prevent life-threatening conditions and provide rapid and high-quality care for all individuals!