During the 1950s, cardiology and cardiac surgery experienced decisive breakthroughs.
Severe disorders of the heart’s electrical system — responsible for a significant slowing or even a complete stoppage of the heartbeat — could now be treated with external pacemakers. Potentially life-threatening arrhythmias, in turn, could be corrected by defibrillation.
These innovations saved lives. However, one problem remained: complications did not occur only during surgery.
Complications Possible Anywhere in the Hospital
In the hours or days following cardiac surgery, rhythm disturbances could develop.
Patients hospitalized after a myocardial infarction were also at high risk of sudden arrhythmias.
In addition, the loss of strength of the heart muscle could lead to further complications. When the heart’s pumping function weakens, heart failure may develop, further complicating the clinical course.
The heart therefore remained vulnerable, even after a successful procedure.
Immediate Response in the Operating Room
In the operating room, everything was in place to respond quickly. Trained personnel and specialized equipment were already at the patient’s bedside.
The delay between a complication and intervention was minimal. This rapid response significantly improved survival chances.
A Longer Response Time Elsewhere in the Hospital
However, once patients were distributed to different hospital units, the situation changed.
When a complication occurred — a severe rhythm disturbance, cardiac arrest, or a rapid decline in the heart’s ability to pump bloodBlood is composed of red blood cells, white blood cells, platelets, and plasma. Red blood cells are responsible for transporting oxygen and carbon dioxide. White blood cells make up our immune defense system. Platelets contribute to blood effectively — the time required to recognize the problem, alert the team, and bring the necessary equipment could increase.
In other words, when bloodBlood is composed of red blood cells, white blood cells, platelets, and plasma. Red blood cells are responsible for transporting oxygen and carbon dioxide. White blood cells make up our immune defense system. Platelets contribute to blood circulation becomes unstable and organs are no longer adequately supplied, every minute counts.
In some cases, this delay could unfortunately be fatal.
Dr. Desmond Julian’s Reflection
In the early 1960s in London, Dr. Desmond Julian was deeply troubled by a disturbing reality: many patients suffering a myocardial infarction were dying from cardiac arrest despite the existence of effective treatments.
Frustrated by this situation, he wrote in a medical journal that several cardiac arrests associated with acute myocardial infarction could be treated promptly… if trained staff and appropriate equipment were immediately available.
The problem was therefore not solely medical. It was organizational.
Bringing Together the Winning Conditions
Two years later, in several American cities, a new approach began to take shape.
The decision was made to group patients with myocardial infarction into a single unit equipped with:
- a defibrillator
- a pacemaker
- a continuous cardiac rhythm monitoring system
For the first time, heartbeats could be observed in real time on monitors. Teams could intervene within the very first seconds of a complication.
Coronary care units were born.
Results That Raised Concerns
Early American data reported a significant reduction in mortality among patients hospitalized for myocardial infarction.
Despite these encouraging results, the idea was not unanimously accepted.
Resistance to Change
Disappointed that he was unable to implement this model in London, Dr. Julian left England for Australia, where he successfully established a functioning coronary care unit.
He later published his experience.
His submission was promptly rejected by the prestigious British Medical Journal, on the grounds that it would be imprudent to recommend the systematic hospitalization of all myocardial infarction patients in a single unit without definitive proof of benefit.
History would later show that his intuition was correct.
As is often the case in medicine, major advances do not rely solely on the discovery of a drug or a new technology, but also on new ways of organizing care.
The Major Impact of Coronary Care Units
Coronary care units quickly demonstrated their effectiveness.
Statistics showed a marked reduction in mortality among patients hospitalized after myocardial infarction.
The principle was simple: continuous monitoring and immediate intervention.
Over time, these units became even more specialized.
In addition to defibrillators, pacemakers, and personnel trained in cardiac resuscitation, new tools were introduced.
Among them, one device drew particular attention: the Swan-Ganz catheter, developed by Drs. Jeremy Swan and William Ganz.
A Better Understanding of How the Heart Functions
The Swan-Ganz catheter is a small, flexible tube inserted into a vein and advanced into the heart and pulmonary arteries.
It allows measurement of various pressures within the heart and helps assess its ability to pump bloodBlood is composed of red blood cells, white blood cells, platelets, and plasma. Red blood cells are responsible for transporting oxygen and carbon dioxide. White blood cells make up our immune defense system. Platelets contribute to blood effectively.
In other words, it provides a precise snapshot of the heart’s pumping performance.
This continuously available information helps the medical team quickly adjust treatment.
Medications can be administered intravenously to support heart contraction or stabilize bloodBlood is composed of red blood cells, white blood cells, platelets, and plasma. Red blood cells are responsible for transporting oxygen and carbon dioxide. White blood cells make up our immune defense system. Platelets contribute to blood circulation.
A Spectacular Decline in Mortality
There is little doubt that the organization of care in coronary care units contributed to a major improvement in the prognosis of myocardial infarction.
By the mid-1960s, in-hospital mortality from heart attacks had fallen from approximately 30% to 15%.
This impressive reduction illustrates how improved organization of care, combined with continuous monitoring, can transform the outcome of an acute illness.
Coronary Intensive Care Units Today
Today, technology has developed considerably.
What were once called “coronary care units” have evolved into Coronary Intensive Care Units (CICUs), true specialized centers dedicated to acute cardiology.
Each room is equipped with state-of-the-art technology.
The space is designed to accommodate monitoring systems, diagnostic equipment, and advanced therapeutic devices simultaneously.
Continuous and Integrated Monitoring
Admitted patients benefit from constant monitoring of heart rhythm, bloodBlood is composed of red blood cells, white blood cells, platelets, and plasma. Red blood cells are responsible for transporting oxygen and carbon dioxide. White blood cells make up our immune defense system. Platelets contribute to blood pressure, oxygen levels, and other essential parameters.
Modern systems allow:
- immediate detection of rhythm disturbances
- rapid identification of a decline in the heart’s pumping capacity
- automatic alerts to the care team
Intervention can therefore begin within seconds.
Comprehensive Treatment On Site
All necessary care for a person experiencing a coronary event — what was once commonly called a “heart attack” — is now available rapidly, often in the same location.
This includes:
- administration of specialized medications by infusion
- temporary cardiac pacing
- mechanical circulatory support, when needed
This integrated organization of care has profoundly changed the prognosis of myocardial infarction.
A Remarkable Decline in Mortality
Thanks to continuous monitoring, rapid access to intervention, and improved treatments, in-hospital mortality from acute myocardial infarction is now below 5–8% in many specialized centers.
This represents a major advance compared with previous decades.
An Evolution That Saves Lives
What was, in the 1960s, an organizational innovation has become an international standard.
Modern CICUs demonstrate that in cardiology, rapid intervention, team coordination, and technological integration can radically transform the outcome of an acute illness.
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