cardiac critical care?

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Jonathan13180

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Is this a specific fellowship? While I am interested in CVICU, it seems as though the CV surgeons do most of the work, and everyone else follows their lead. However, as I am more and more interested in CVICU, I am wondering if others out there could shed some light on this career choice from a non-CT surgeon.

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Is this a specific fellowship? While I am interested in CVICU, it seems as though the CV surgeons do most of the work, and everyone else follows their lead. However, as I am more and more interested in CVICU, I am wondering if others out there could shed some light on this career choice from a non-CT surgeon.

Get out in the private world and the CV surgeons prefer not to do most of this work. You'll need an extra one year in a critical care program after cardiology fellowship to sit for boards and they have places that will do this for you.
 
I'll share what I know from the side of congenital heart disease: in this world "cardiac intensivists" are usually trained either as peds intensivists who did extra training in cardiology (+/-[?] boarding in cardiology) or cardiologists who did a 1 year fellowship in CVICU (no boarding in PCCM) or got boarded in PCCM via doing longer training (typically 2-3yrs) in CCM. If you look at Pitt's web site, they also take neonatologists and anesthesiologists. The anesthesia route is probably much more common of the two, as it's far less typical for neos to follow this course. Last I knew the CVICU at Mayo (which cares for all cardiac cases, congenital or otherwise) was run by the cardiac anesthesiologists. Likewise there are congenital heart centers in which the heart cases are taken care of by the intensivists who don't have specific extra training in CVICU (i.e. while it is highly marketable training to have, it isn't a requisite to have to take care of hearts in all places). Not all of this model applies to adult CVICU training/care, but some does.
 
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I did research at Stanford this summer and was inquiring about the same thing. Most of their attendings are anesthesiologist with both a CC and CV fellowship.
 
Is this a specific fellowship? While I am interested in CVICU, it seems as though the CV surgeons do most of the work, and everyone else follows their lead. However, as I am more and more interested in CVICU, I am wondering if others out there could shed some light on this career choice from a non-CT surgeon.

As the others have said, there are multiple pathways. Assuming you're looking for the adult, non-surgical route.

  • Anesthesia (4) + CCM (1) +/- Cardiac anesth (1) = 5-6
  • IM (3) + CCM [+/- Pulm] (2-3) = 5-6
  • IM (3) + Cards (3) + CCM (1) = 7

In academics, I have seen varying levels of involvement by CT surgery in the postop ICU management of their patients. For the anesthesia route, I think the cardiac anesthesia fellowship is not mandatory. Yes, it is common at certain academic centers, but not universal. We (CCF) have CCM attendings with and without CTA fellowships in the CVICU. As long as you are comfortable with echo, and management of cardiac surgical pts.
 
As the others have said, there are multiple pathways. Assuming you're looking for the adult, non-surgical route.

  • Anesthesia (4) + CCM (1) +/- Cardiac anesth (1) = 5-6
  • IM (3) + CCM [+/- Pulm] (2-3) = 5-6
  • IM (3) + Cards (3) + CCM (1) = 7

In academics, I have seen varying levels of involvement by CT surgery in the postop ICU management of their patients. For the anesthesia route, I think the cardiac anesthesia fellowship is not mandatory. Yes, it is common at certain academic centers, but not universal. We (CCF) have CCM attendings with and without CTA fellowships in the CVICU. As long as you are comfortable with echo, and management of cardiac surgical pts.

My bias was clearly showing :laugh:

Probably the most logical route would be the anesthesia pathway if one is looking to do mostly cvicu I would think.
 
Cardiac SICU credentialing doesn't require any specific training over CCM. Essentially any intensivist can work including medicine CCM as well as EM/CCM (as in my current institution). You'll find many CSICUs are staffed with midlevels because most of the patient care can be protocol driven. I don't agree with that model but it works.

What is the ideal training? That's very hard to say. I would consider the ability to do diagnostic TEE to be mandatory in this population, but that's not very common. Many academic (and even some private) hospitals also use cardiac anesthesiologists. If a hospital cares about Leapfrog, cardiac anesthesiologists are not considered intensivists. There is a very real benefit of knowing how the operation is done which I think is less important in other SICU populations. I can't really recommend someone do a combined CCM + cardiac anesthesia fellowship unless they were really 100% set on doing CSICU, the return on investment just isn't there.
 
Cardiac SICU credentialing doesn't require any specific training over CCM. Essentially any intensivist can work including medicine CCM as well as EM/CCM (as in my current institution). You'll find many CSICUs are staffed with midlevels because most of the patient care can be protocol driven. I don't agree with that model but it works.

What is the ideal training? That's very hard to say. I would consider the ability to do diagnostic TEE to be mandatory in this population, but that's not very common. Many academic (and even some private) hospitals also use cardiac anesthesiologists. If a hospital cares about Leapfrog, cardiac anesthesiologists are not considered intensivists. There is a very real benefit of knowing how the operation is done which I think is less important in other SICU populations. I can't really recommend someone do a combined CCM + cardiac anesthesia fellowship unless they were really 100% set on doing CSICU, the return on investment just isn't there.

I agree that both fellowships aren't necessary. There are a few combined 18 month programs for the inclined.
 
I agree that both fellowships aren't necessary. There are a few combined 18 month programs for the inclined.

I didn't think that the 18month programs existed anymore, now that CT is an ACGME accredited fellowship. My ideal job involves both CT anesthesia in the OR, and running the CTICU, so if I only have to do one fellowship, rather than two, that would be awesome.
 
What if you get TEE certified (real deal certified) via an anesthesia CCM fellowship? Duke is one such program that I can think of. I presume you could still be able to do CV anesthesia in the OR as there are still new grads doing CV call for groups that are not TEE certified.
 
IABP deflates during systole and inflates during diastole, right? Pocket Medicine, pg 1-15 says otherwise.
 
IABP deflates during systole and inflates during diastole, right? Pocket Medicine, pg 1-15 says otherwise.

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IABP deflates during systole and inflates during diastole, right? Pocket Medicine, pg 1-15 says otherwise.

Depends on if it is referring to "balloon" systole/diastole or "patient" systole/diastole. These are opposite terms but can both be used to describe the augmentation cycle of an IABP. An IABP deflates during "patient" systole but inflates during "balloon" systole.

As PMPMD said, if it says that it inflates during "patient" systole then it is incorrect.
 
Doing CCM fulfills cardiovascular disease fellowship requirement but not TEE training requirement - impossible to get all cases in a CCM fellowship for TEE certification. Would be surprised if Duke could really pull that off in 12 months.
 
Doing CCM fulfills cardiovascular disease fellowship requirement but not TEE training requirement - impossible to get all cases in a CCM fellowship for TEE certification. Would be surprised if Duke could really pull that off in 12 months.

Then you should be surprised. They get their numbers at the main ORs and at the Durham VA (where they do all the TEEs for the hospital).
 
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