Abstract 12925: MICU Overflow Patients in the Cardiac Intensive Care Unit: Insights From the Critical Care Cardiology Trials Network Registry

Abstract

Background: The cardiac intensive care unit (CICU) is designed to manage critically ill patients (pts) with acute cardiovascular (CV) conditions, but may be the site of care for pts with non-CV critical illness when medical ICU (MICU) beds are unavailable. Methods: The Critical Care Cardiology Trials Network (CCCTN) is a multicenter registry of consecutive admissions to CICUs in North America coordinated by the TIMI Study Group. Pts with no acute or major cardiac issues were designated as MICU overflow and were compared to those admitted with acute CV illness. A generalized mixed-effect regression model was used to adjust for age, sex, Sequential Organ Failure Assessment (SOFA) score and cardiac arrest while accounting for variability among centers. Results: Among 18,006 CICU admissions, 778 (4.3%) were MICU overflow, with a range of 0% to 26% among centers. MICU overflow rates trended lower over time (Fig-A) . In comparison to admissions with acute CV illness, MICU overflow patients were younger (60.0 vs 67.0 y, p<0.001) and more likely to be female (45.6 vs 36.7%, p<0.001). Comorbidities differed markedly between the 2 groups (Fig-B) . Presentation with cardiac arrest was more common among admissions with acute CV illness (12.9% vs 4.5%, p<0.001). MICU overflow admissions had higher SOFA scores than those with acute CV illness (5.0 vs 3.0, p<0.001). Resource utilization is shown in Fig-C . ICU LOS was similar (2.0 vs 2.2d, p=0.4). MICU overflow status was associated with a trend in CICU mortality (adj-OR 1.19, 95% CI 0.93-1.53, p=0.16) and significantly higher hospital mortality (adj-OR 1.69, 95% CI 1.36-1.73, p<0.001) (Fig-D) . Conclusions: MICU overflow pts constitute a meaningful number of admissions to CICUs. These pts have more multi-system disease, greater baseline organ dysfunction, and higher hospital mortality than pts with acute CV illness. These findings reinforce the need for multidisciplinary CICU teams with expertise in all facets of critical care.