CVICU Intensivists Play Critical Role for Heart Patients

In honor of American Heart Month, we spoke to Dr. Michele Domico, medical director of CHOC’s cardiovascular intensive care unit (CVICU), on the importance of having a cardiac intensivist on a child’s heart surgery team.

Domico, Michele

Q: What role does the cardiac intensivist play in a patient’s overall care?

A: Heart patients will be seen by several doctors during their stay in CHOC’s CVICU. In addition to their cardiovascular surgeons making rounds in the unit, patients will also be regularly visited by their cardiologists who will also manage their care after they go home. But in addition to that care, pediatric heart patients also need a critical care specialist on hand at all times who can care for any unexpected complications that may arise. CHOC’s CVICU has an attending physician in the unit at all times, day or night, to care for our heart patients, and not all heart programs have that.  We are also the only place in Orange County that performs neonatal and pediatric open-heart surgery, and have outcomes above the national averages for overall survival rate and neonatal survival rate.

Q: Why is it important for parents to make sure there is a cardiac intensivist on their child’s heart surgery team?

A: General intensivists have training in treating infections, traumas, cardio-respiratory disorders, and other severe problems that may arise. A cardiac intensivist has additional training in caring for exclusively for the most critically ill cardiac patients with severe and rare heart disorders. Patients benefit from having cardiac intensivists on their care teams because they’re prepared to care for any complication that may occur.

Patients with certain heart conditions may require a series of surgeries throughout their childhood. Since there is a cardiac intensive care specialist on call in the CVICU at all times, we really get to know the families we care for. There’s not a single patient who comes to the CVICU for their second surgery that we don’t remember from their first operation. That continuity of care means peace of mind for parents, knowing their child’s heart team knows everything about them.

Q: Why is it important for children to see a pediatric subspecialist for their heart condition?

A: Adult cardiac doctors are trained on structurally normal hearts, where all the pieces of the heart puzzle are intact and everything is in the right place. But children with congenital or acquired heart conditions may have missing or misplaced pieces of their hearts and need specialized care. As pediatric heart specialists, we see patients every day who have unique and severe heart conditions, so we are especially able to care for them.

Learn more about the life-saving equipment and expertise available to patients in CHOC’s Heart Institute.

Related articles:

February is American Heart Month — Cyrus’ story

Just in time for American Heart Month, learn about our courageous patient, Cyrus, who underwent complex open heart surgery. His successful journey was met by much celebration from his family and his team of CHOC experts.

Hypoplastic Left Heart Syndrome (HLHS) is a rare congenital heart defect, which is 100 percent fatal if left untreated. Sunny and Jereme Brixey knew about their baby’s risks even before Cyrus was born in 2008, having been prenatally diagnosed.

Prior to Cyrus’ birth, the cardiac team at CHOC Children’s already had a plan of action: an approach involving three different open heart surgeries. Three days after he was born, Cyrus underwent complex open heart surgery. He had a second heart surgery at 4 months and a third at 4 years.

After the third procedure in 2013, Cyrus took a long time to recover in the hospital. After being in the hospital for nearly two months due to persistent drainage from a chest tube, Cardiovascular Intensive Care Unit (CVICU) physician Dr. Michele Domico suggested that Cyrus could be discharged home with a portable chest drain. He would be the first patient in the hospital’s history to be sent home with this device. The cardiologists and surgeons agreed and ordered the new portable chest drain for Cyrus, allowing him to go home.

Cyrus, with Dr. Michele Domico, medical director of CHOC Children's CVICU and Choco, at a CHOC Night at Angels Stadium event.
Cyrus, with Dr. Michele Domico, medical director of CHOC Children’s CVICU and Choco, at a CHOC Night at Angels Stadium event.

At home, Cyrus’ parents took care of him and his chest drain so that he could heal, and the drain was able to be removed after a few weeks. This successful procedure was met by a large cheer from Cyrus’ entire CHOC team. For Sunny and Jereme, this expression of joy reflected the care Cyrus received every step of his journey. In addition to the clinical excellence of the medical team, the Brixeys believe the team’s positive, encouraging words, as well as the support extended to the entire family, were a huge factor in his recovery. Since then, the CVICU team has used the portable chest drain in several other patients with great success.

Learn more about the CHOC Children’s Heart Institute.


Related posts:

How ECMO Can Save a Child’s Life

DomicoBy Dr. Michele Domico, medical director, CHOC Children’s ECMO service

Children who are hospitalized with critical cardiac or pulmonary disease and don’t respond to current medical treatments might be candidates for a life-saving device called extracorporeal membrane oxygenation (ECMO).

ECMO (also known as extracorporeal life support) is a heart and lung bypass machine that can be used to rest a failing heart or lungs, providing complete support for a few days, or even weeks, until the heart and lungs recover.

A physician from CHOC Children’s ECMO team can evaluate a child to see if he or she is a candidate for this specialized treatment. ECMO is not offered to every patient because it is a high-risk procedure with possible complications. However, ECMO has saved many children’s lives when all else failed.

CHOC was one of the first centers to use this life-saving device, to saving a newborn infant dying from lung disease in 1975. Since then, ECMO has become widely used for infants and children with certain life threatening lung or heart problems. CHOC remains today the only hospital in Orange County to provide this complex life-saving treatment.

ECMO is most often used for children born with congenital heart defects, post-surgical patients and children with severe pneumonia. In 2012, CHOC published a practice-changing study that suggested expanding the use of ECMO for patients with severe lung disease or pneumonia who were previously not considered ECMO candidates.

More broadly, the CHOC ECMO program has made great strides in recent years, with state-of-the art equipment, an increased number of patients, excellent outcomes and improved ECMO specialist training.

The platinum-level Extracorporeal Life Support Organization (ELSO) Award of Excellence in Life Support recognizes programs worldwide that distinguish themselves by having evidence-based processes, procedures and systems in place that promote excellence in ECLS. As a recipient of a platinum designation, CHOC is among the highest scoring institutions.

More posts about cardiology:

CVICU Provides Special Post-Procedure Care to Heart Patients

Patients who have undergone complex, cardiovascular procedures at the CHOC Children’s Heart Institute require specialized care and attention. At CHOC, they get just that in a dedicated, 12-bed Cardiovascular Intensive Care Unit (CVICU).

In CHOC’s CVICU, children receive attention from pediatric cardiac-trained intensivists, nurse practitioners, critical-care registered nurses, and an interdisciplinary medical team. All rooms are private and fully equipped with leading-edge technology that meets the demands of monitoring and treating children with heart problems, and those who have undergone complex heart surgery and heart catheterization procedures. CHOC is the only facility in Orange County that performs open heart surgery on newborns and children.

That combination of well-trained experts and topnotch facilities can lead to improved patient outcomes. The Heart Institute has outcomes above the national averages for overall survival rate and neonatal survival rate. CHOC is routinely named to the Leapfrog Group’s annual list of Top Children’s Hospitals, recognizing a commitment to provide the safest and highest quality of health care.

“Cardiovascular patients are unique and delicate. They require complex care and management. CVICU staff members understand these kids’ physiology,” says Allie Quill, RN, a clinical outcomes coordinator at CHOC. “When our patients get into trouble, their treatment is not routine. All of our kids are so different and require such fine tuning.”

CVICU care team

Cardiac pediatric subspecialists are especially trained to care for heart patients in need of critical care, and they have advanced knowledge of cardiovascular disorders.

“Pediatric heart specialists have extra training and experience in caring for children with unique and severe cardiac disorders, something a general care team or an adult cardiac doctor may not be as comfortable with,” says Dr. Michele Domico, medical director of the CVICU.

The CVICU’s design also plays a critical role in improving outcomes for patients. The space encourages parent-clinical caregiver interaction, and ensures a peaceful, healing environment.  Our staff recognizes the role that loved ones play in patient healing.

Each private CVICU patient room is divided into three areas:

  • The first area, closest to the doorway, is the nurse’s zone. Here, visitors will notice a wheeled cart that holds a computer and supplies to allow bedside charting and full access to patients.
  • The second area belongs to the patient, and features gas hook-ups, monitors and other equipment.
  • The third area is the parent zone, which includes a sleep sofa, reading light, sink, telephone and other amenities to ensure family comfort.

The CHOC CVICU also includes two fully-equipped procedure rooms that allow physicians to perform life-saving surgery on patients who otherwise could not be transported out of the unit.

Certain heart conditions warrant a series of surgeries throughout childhood, necessitating several stays in the CVICU. For that reason, CVICU staff members often develop close and lasting relationships with patients and families.

“Parents often come back and visit us after their child has been discharged, to thank us for taking special care of their child,” says Domico. “Every year our team receives dozens of school photos and holiday cards from families who we were fortunate enough to bond with in the CVICU. It’s a privilege to see the children we’ve treated grow up and have a healthy childhood.”

Learn more about CHOC’s CVICU.

Related articles: