ECG monitoring in ICU

ECG monitoring in ICU

Coronary care units were started in the 1960s with the aim of monitoring ECG carefully in patients with heart attack. Later various other biomedical signals have been added to the monitoring facilities in intensive care units. Most important goals of ECG monitoring in the intensive coronary care unit (ICU) are heart rate and basic rhythm determination as well as diagnosis of complex heart rhythm abnormalities (cardiac arrhythmia). Early detection and prompt treatment of life threatening heart rhythm disorders and thereby saving lives were the initial reasons for development of intensive monitoring facilities.

Over the past few decades since the initiation of ECG monitoring in the 1960s, several improvements have occurred. They include improved noise reduction strategies, multilead monitoring and derived 12-lead ECGs. Cardiac arrhythmia monitoring is needed for all patients at significant risk of an immediate, life-threatening arrhythmia, which include care after recovery from a cardiac arrest, early phase of heart attack, after heart surgery and after anaesthesia.

Battery-operated monitor-defibrillators are useful while transporting such patients. Personnel watching the monitor in the ICU should have skill in ECG interpretation and defibrillation. Defibrillation is the controlled delivery of a high voltage electrical shock to the chest wall for emergency treatment of life threatening cardiac arrhythmia.

In the setting of heart attack, ECG monitoring is useful to assess whether the blocked blood vessel of the heart which was opened up by clot dissolving medications or angioplasty has been occluded again. Angioplasty is the process of removing blocks using small tubes with balloons at the tip, introduced through blood vessels at the wrist or groin.

While monitoring ECG in the ICU, the electrode wires usually kept on the limbs are attached to the parts of the body nearest to the limbs. This is to reduce the pick up of unwanted signals from the muscles during movements of limbs. Attachment to the body also avoids tethering of the person.