1

CARDIAC INTENSIVE CARE

UNIT ADMISSION CRITERIA
Cardiac Intensive Care, Second
Edition
Allen Jeremias, andDavid L. Brown
CHAPTER 3, 25-35
By:
Dr. Dinarsari HP

Pembimbing:
Dr. Setyasih Anjarwani, SpJP (K)

Parameter
2

Paramet
er

Diagnosis
System

Objective

Cardiovascular Conditions Requiring

Admission to the Cardiac Intensive Care Unit
3

Chest pain, acute coronary syndromes, and acute myocardial infarction

Acute decompensated heart failure
Pulmonary hypertension
Arrhythmias
Sudden cardiac death
Cardiogenic shock
Conditions requiring IABP or other forms of mechanical circulatory
support
Adult congenital heart disease (decompensated)
Valvular heart disease (with hemodynamic instability)
Aortic dissection
Hypertensive emergency
Cardiac tamponade
Pulmonary embolism (massive or submassive)
Postprocedure monitoring (percutaneous coronary intervention and
electrophysiologic study)

Indications to Guide Where to Admit

Patients with Acute Chest Pain in Intensive
Care Unit

One of the following:

Substantial ischemic ECG changes in two or more

leads that are not known to be old

ST segment elevation 1 mm or Q waves of 0.04

second

ST segment depression 1 mm or T wave

inversion consistent with the presence of ischemia

Indications to Guide Where to Admit

Patients with Acute Chest Pain in Intensive
Care Unit (cont)

Two of the following, with or without substantial ECG

changes:

Coronary artery disease known to be unstable (in

terms of frequency, duration, intensity, or failure to
respond to usual measures)

Systolic blood pressure <100 mm Hg

Serious new arrhythmias (new-onset atrial fibrillation,

atrial flutter, sustained supraventricular tachycardia,
second degree or complete heart block, or sustained
or recurrent ventricular arrhythmias)

Indications to Guide Where to Admit Patients

with Acute Chest Pain in Intermediate Care Unit
6

Any of the following conditions but meeting no criteria for intensive

care:
Coronary
Systolic

artery disease known to be unstable

blood pressure <110 mm Hg

Rales

above the bases

Major

arrhythmias (new-onset atrial fibrillation, atrial flutter, sustained

supraventricular tachycardia, second-degree or complete heart block,

or sustained or recurrent ventricular arrhythmias
New

onset of typical ischemic criteria that meet the clinical criteria for

unstable angina and that occur at rest or with minimal exertion

Indications to Guide Where to Admit Patients

with Acute Chest Pain in Evaluation Unit / Home
7

Evaluation or Observation Unit

New-onset symptoms that may be consistent with

ischemic heart disease, but are not associated with
ECG changes or a convincing diagnosis of unstable
ischemic heart disease at rest or with minimal exertion

Known coronary artery disease whose presentation

does not suggest a true worsening, but for which
further observation is thought to be beneficial

Home with Office Follow-up in 7-10 Days to Determine

Whether Further Testing Is Needed

Heart Failure condition that requires

admission to the CICU
8

Weingarten, et alfound that admission for

heart failure is for a high-risk event. In this
study,low riskis defined as patients without

acute MI or ischemia
active or planned cardiac interventions
unstable comorbidity
worsening clinical status
lack of response to diuretic therapy

Multiorgan dysfunction in the setting of heart

failure

Arrhythmia condition that requires

admission to the CICU
9

The decision depends on the underlying

rhythm disturbance, and whether it is
associated with signs and symptoms of
hemodynamic instability

Objective Parameters Model

Vital Signs

Pulse < 40 or > 150 beats/minute

Systolic arterial pressure < 80 mm Hg or

20 mm Hg below the patient's usual
pressure

Mean arterial pressure < 60 mm Hg

Diastolic arterial pressure > 120 mm Hg

Respiratory rate > 35 breaths/minute

Objective Parameters Model

Laboratory Values (newly discovered)

Serum sodium < 110 mEq/L or > 170 mEq/L

Serum potassium < 2.0 mEq/L or > 7.0 mEq/L

PaO2 < 50 mm Hg

pH < 7.1 or > 7.7

Serum glucose > 800 mg/dl

Serum calcium > 15 mg/dl

Toxic level of drug or other chemical substance

in a hemodynamically or neurologically

Objective Parameters Model

Radiography/Ultrasonography/Tomography(newly
discovered)
Cerebral vascular hemorrhage, contusion or
subarachnoid hemorrhage with altered mental
status or focal neurological signs
Ruptured viscera, bladder, liver, esophageal varices
or uterus with hemodynamic instability
Dissecting aortic aneurysm

Electrocardiogram
Myocardial infarction with complex arrhythmias,
hemodynamic instability or congestive heart failure
Sustained ventricular tachycardia or ventricular
fibrillation

Objective Parameters Model

Physical Findings (acute onset)

Unequal pupils in an unconscious patient

Burns covering > 10% BSA

Anuria

Airway obstruction

Coma

Continuous seizures

Cyanosis

Cardiac tamponade

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CHEST PAIN ASSESMENT

15

Kate ODonnovan. Assesment of Chest Pain. Continuing Education

Nov 2001 Vol 19

16

Kate ODonnovan. Assesment of Chest Pain. Continuing Education

Nov 2001 Vol 19

17

Kate ODonnovan. Assesment of Chest Pain. Continuing Education

Nov 2001 Vol 19

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TERIMAKASIH
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