Patients with critical cardiac illness, who are not recovering from heart surgery, are cared for in the Cardiac Intensive Care Unit (CICU). This includes patients with heart attack or severe heart failure who are awaiting a heart transplant or implantation of a ventricular assist device.
Roman W. DeSanctis, MD, Endowed Distinguished Scholar in Medicine
Each patient in the CICU is cared for
and monitored around-the-clock
Cardiac Intensive Care Unit
Multidisciplinary Patient Care
Under the leadership of Medical Director James Januzzi, Jr., MD, the Cardiac Intensive Care Unit (CICU) is staffed by a multidisciplinary team of health care providers who work collaboratively to provide high quality care for this critically ill patient population. The team includes an attending cardiologist, a pulmonary critical care intensivist, an attending physician specializing in heart failure and a cardiac fellow-in-training. The pulmonary intensivist, added to the CICU staff after a 2010 pilot program, adds expertise for patients with complex, co-morbid (multiple) medical conditions and improves the safety and care of all CICU patients.
Completing the multidisciplinary team are specialists in patients with severe heart conditions, including:
- A staff of approximately 70 cardiology critical care nurses
- Respiratory therapists
- Clinical pharmacists
- Palliative care specialists
- Mental health professionals and social workers
- Physical, occupational and speech therapists
- Case managers
What to Expect
CICU, a 16-bed facility, cares for approximately 1,200 patients annually. These patients suffer from both common and rare heart conditions. They may have undergone procedures in Mass General's Knight Cardiac Catheterization Laboratory, suffered acute myocardial infarction (heart attack), are severe heart failure patients awaiting heart transplant at Mass General’s Transplant Center or are receiving a ventricular assist device. These patients enjoy access to a broad range of world-class interventional cardiology services. The CICU’s close affiliation with the hospital’s Heart Center, including the Cardiac Surgery department and Cardiac Surgery ICU, provides a continuum of care that enhances the patient experience.
Patients and their families can expect to participate in the discussions and plans for their care, to learn about treatment options and prognosis and to be part of all decisions affecting their care.
Leading the Way with New Treatments
Since the early 2000s, the CICU has emerged as a regional leader in hypothermia treatment after cardiac arrest. This treatment, where the patient’s body is cooled to 91°F for 24 hours, helps to reduce the risk of brain injury due to lack of oxygen. Mass General has used hypothermia treatment on approximately 200 patients, including 30 in 2010 alone.
The Importance of Family
The CICU is a leader at Mass General in the concept of “family presencing” during an ICU stay. Family presencing welcomes families at the patient bedside at any time. This access means families may witness a patient under distress, whether from sudden cardiac arrest or a difficult procedure. CICU nurses are trained to educate and console family members during such an event. A nurse is assigned to explain what is happening and why and what to expect. The American Association of Clinical Nurses is funding research at Mass General on the effect of family presencing.
CICU researchers presented findings in March 2011 to the American College of Cardiology on cardiac biomarker testing in a cohort of CICU end-stage heart failure patients. The goal of the clinical research study was to determine if sensitive blood tests that measure biomarkers of heart function can be used to predict likely responses to therapy. Additional ongoing studies include the evaluation of fish oil therapy to reduce sudden cardiac death following a heart attack and the benefits of screening cardiology patients for depression and anxiety. This last study has yielded data on more than 5,000 subjects screened in part in the CICU. Funded by the National Institutes for Health, the fish oil study is significant for examining a widely available, inexpensive therapy with potential to help the large population of patients with acute ischemic heart disease.
The depression and anxiety screening of more than 5,000 cardiology patients at Mass General, including CICU patients, demonstrated that adding two questions to the nursing assessment upon admission, followed by intervention if the patient was positive for depression or anxiety, dramatically reduced post-cardiac diagnosis depression and follow up, and improved outcomes. Cardiology patients with depression or anxiety have a three- to four-fold increased likelihood for recurrent heart attack and death.
CICU nursing staff also contribute to research. In 2008, Heart and Lung journal published a study by Mass General CICU nurses on the effect of nursing in identifying potential risks for errors in patient care and intervention to avoid those errors.
Educating Future Cardiac Intensivists
CICU physicians and nurses teach next-generation medical providers while continuing their own education. On staff at Harvard Medical School, CICU physicians train cardiology fellows and residents who rotate through CICU. There is also an active teaching curriculum for house staff.
Nurse orientation to the CICU lasts 12 weeks. Experienced nurses mentor newer ICU nurses through the Partners Available for Learning (PAL) program. Recent graduates participate in the New Graduate Critical Care Program, a six-month teaching program to acclimate new nurses to the dynamic ICU setting.
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