The Future of the Cardiac Intensive Care Unit

In this video, David Dudzinski, MD, director of the Heart Center Intensive Care Unit, discusses how his team combines the specialties of cardiology intensive care, cardiac anesthesia and cardiac surgery into a unified care team model to take care of the entire span of patients with acute, critical cardiovascular illness.

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Transcript

The idea behind the heart center intensive care unit was to combine the specialties of cardiology intensive care, cardiac anesthesia and cardiac surgery into a unified care team model to take care of the entire span of patients with acute, critical cardiovascular illness. So we have physicians who are board certified in cardiology and intensive care, in cardiac anesthesia and intensive care and in cardiac surgery and in intensive care. By bringing together this multidisciplinary group, we hope to best take care of patients who are periprocedure from the cath lab or the EP lab, who are perioperative from the cardiac OR, who may need evaluation or management of mechanical circulatory support. And so these physicians all have an intimate background in these specific areas. Moreover, there's a lot of data showing that patients in the modern cardiac intensive care unit face a number of noncardiac comorbidities including sepsis, renal failure and respiratory failure. And our intensive care group is designed to treat not only the cardiac, but all the noncardiac comorbidities for these patients.

And so one thing that all of us in the field know is that the cardiac intensive care unit is not the same unit or the same patient population that it was 10 or even five years ago. The patients are generally sicker and have more acute cardiac and hemodynamic abnormalities, which require new therapies. So we really need a specialized program of training to build the physician to be able to be at the bedside and managing not only the mechanical circulatory support device that is supporting the patient minute-to-minute, but also their general cardiac context as well as all noncardiac comorbidities, which include failures of organs including the lungs, the kidneys or the liver.

Our goal at Massachusetts General Hospital is to study what the best care model is for cardiac intensive care. There is a growing but still limited database of care models and care designs. There is a small study from the University of Maryland that showed intensiveness involvement in ventilated cardiac intensive care unit patients, reduced length of stay and actually reduced costs. There was a large trial in Korea, a quasi-experimental design, that studied 2,400 patients over three years and the presence of a dedicated cardiac intensivist actually reduced mortality for overall CCU patients.

So our goal at Massachusetts General Hospital is to bring our intensive care unit team to the bedside 24/7, to provide acute life-saving care to these patients and our other goals are to make sure we train the next generation of physicians. So my own personal goal is to really build a training fellowship for cardiologists to go on to get specialized training in critical care and to fill these roles across the country in the future.

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