Cardiac Intensive Care Unit Supports Heart Institute
from Practice Update, Winter 2004
With the development of The Children’s Hospital Heart Institute, an increasing volume of complex and specialized cases necessitated a dedicated cardiac critical care unit.
Early in 2003, The Children’s Hospital dedicated beds and staff to cardiac critical care. An 11-bed cardiac intensive care unit (CICU) provides comprehensive care for congenital and acquired heart disease patients, from neonates to young adults including
- Diagnosis and stabilization of neonates
- Pre and post operative care
- Care following heart transplants and complex catheter interventions
- Management of complex arrhythmias
- Mechanical circulatory support
In the CICU, specialized equipment is within arm’s reach. From devices designed for specialized intracardiac monitoring to devices allowing sustained mechanical circulatory support, equipment needed to care for kids recovering from open-heart surgery and transplants is available. Couple accessibility of state-of-the-art equipment with staff specifically trained in the care of cardiac patients, and critical care for young heart patients moves up to the next level.
Experience has shown that the collaboration between cardiology, cardiothoracic surgery and the nursing staff in a cardiac critical care unit improves outcomes and survival rates. “Although the 1% incidence of congenital heart disease has remained stable for as long as we’ve been tracking trends, our ability to diagnose and treat complex conditions has lead to increased numbers of children surviving congenital heart diseases. As a result, pediatric cardiologists and surgeons are treating more and more older kids, adolescents and adults. A critical care unit focused on the comprehensive management of cardiac patients here at Children’s allows us to treat a higher volume of cases and treat them more effectively.”
While the volumes of older children and adults are increasing, often it is neonates with cardiac problems who need care in the CICU. Partnering with the Neonatal Intensive Care Unit (NICU) has enhanced our ability to treat these small patients. Dan Hall, MD, medical director for the NICU, explains: “Since newborns often present undiagnosed and have longer length-of-stays, a significant part of their hospitalization may be in the NICU or Infant Care Center . Here, diagnosis can be established, a plan of care developed and critical care stabilization provided while awaiting surgery. Following post-operative recovery, an extended stay in the Infant Care Center promotes nutrition, early infant development and family interaction.”
The CICU is the key to a cardiovascular program’s success in providing comprehensive patient care. The CICU promotes collaboration that extends to community physicians and, by involving primary care providers in the pre and post-operative management approach, patients and their families go into surgery better prepared and tend to recover more quickly. Focused cardiac care allows the integration of inpatient and outpatient care on a scale not seen before. “By including the primary care provider in the team of pediatric specialists of cardiologists, anesthesiologists, congenital heart surgeons and cardiac intensivists we can establish a continuum of care that facilitates the best outcomes.”
As The Heart Institute grows, The Children’s Hospital in Denver becomes part of a network of large pediatric cardiovascular centers across the country. Dr. Ivy explains the importance of being a participant in the network of leading centers, “Children’s is probably among the top dozen pediatric cardiac centers right now. Some of our programs, such as the heart transplant and pulmonary hypertension programs, are already the top one or two in the country. Within three or four years, The Children’s Hospital Heart Institute in Denver will be ranked among the nation’s largest and most successful pediatric heart centers. Being a part of this upper echelon opens the potential for sharing data management and operational systems, spurs collaborative research, and promotes the sharing of ideas in the treatment of complex conditions. All of these ultimately benefit patient care. I think there’s a lot of interest around the country in our program here in Denver , especially among younger cardiologists and surgeons who are attracted by the opportunity to contribute to a rapidly growing and progressive pediatric cardiovascular program.”
By achieving a certain volume threshold, it becomes practical to share information about integrated patient management systems with other large hospitals. “We expect to increase surgical volume to more than 600 cases annually. The expertise we have in-house with our team of CT surgeons, Drs. Lacour-Gayet, Campbell, Mitchell and Clarke, makes that volume sustainable. The CICU is an important component in supporting this volume of patients. With our program’s ability to accurately diagnose all types of congenital heart diseases and the CICU’s ability to stabilize patients before intervention, rapidly deploy extracorporeal circulatory assist devices, and support complex catheter based interventions, we can expand the surgeons’ ability to effectively treat patients with complex congenital and acquired heart diseases.”
The CICU provides a key environment for pediatric cardiac research and training of future pediatric cardiologists. Combining basic philosophies rooted in pediatric cardiology, cardiac surgery, and cardiac anesthesia, carefully constructed management protocols implemented in the CICU allow for systematic evaluation and modification of existing or new treatment techniques. With the advancement of most clinical sciences benefiting from integrated systems of patient care, the CICU concentrates patients with rare medical conditions allowing for valuable insights into the underlying pathophysiology and disease patterns in both lethal and non-lethal pediatric heart diseases.
In conclusion, Dr. Ivy explains the significance of focused cardiac care: “The development of a heart institute capable of treating large volumes of patients and consistently achieving the best outcomes presumes a dedicated cardiac critical care unit. At Children’s we have consolidated the expertise of many disciplines within the CICU. To have a cardiac intensive care unit in place supports The Children’s Hospital Heart Institute and the potential for becoming one of the best pediatric heart centers in the country.”
