Historical Perspectives, Current Developments and Future Challenges in Critical Care Medicine

Abstract

The ICU, now common place in hospitals evolved from three main sources, according to Hilberman. First was the postoperative recovery unit, the first of which was established for neurosurgical patients at the Johns Hopkins Hospital in Baltimore in 1923. This and other recovery units were the forerunners of today’s surgical ICUs (SICUs).The first medical ICUs (MICUs) were created primarily to care for patients with respiratory failure caused by poliomyelitis and other neuromuscular diseases. The first coronary care units (CCUs) were established in 1962 at Toronto General Hospital, Bethany Hospital in Kansas City, and Presbyterian Hospital in Philadelphia. Specialized units for neonatal and pediatric patients, patients with burns and neurosurgical problems, and patients recovering from heart surgery were developed after SICUs, MICUs, and CCUs were established. The now more simplified CPR interventions were extended to the larger domain of both professional and lay rescuers. The first national guidelines for what to teach to whom and how, was published in 1966.Guidelines were also developed under the auspices of the World Federation of Societies of Anesthesiologists, which expanded guidelines for advanced life support, including cerebral resuscitation.In the decade that followed the first National Conference on Standards for CPR and Emergency Cardiac Care was organized under the auspices of the American Heart Association (AHA), which thereafter assumed increasing responsibility for professional leadership of the field, both nationally and later internationally. Major efforts to improve outcomes from sudden cardiac death were intended to keep pace with an increasing incidence of cardiac arrest in communities with a predominance of elderly patients with ischemic heart disease. Still, only 4% to 9% of victims of cardiac arrest survive, and the scope of this worldwide epidemic prompted increasing international concern among industrialized nations. After the 2000 International Conference on the science of resuscitation, conferences have been scheduled on an international basis every 5 years, and the recommendations serve as the basis of national guidelines that fulfill local needs. Yet, the emergence of well-trained rescue services have failed to continue to improve outcomes, except in unique public settings in which there is immediate access to CPR. It became apparent that CPR must be begun within less than 5 minutes.