Clinical Experience

Clinical Experience

The clinical experiences of the Pediatric Cardiac Critical Care Fellowship program are specifically designed to train future attending physicians with clinical practice focused on children in the pediatric cardiac intensive care unit.

Pediatric CICU (20 weeks)

• Provide daytime service on average 6 days/week when on service and average of 1 night/week scheduled in 2 or 4-week blocks
• Team structure: Attending physician, 4^th year PCCC fellow, up to 1 PICU or cardiology first year fellow, 1-2 APPs. Typical census 8-12 patients

Cardiac Anesthesia (4 weeks)

• Assigned to CVOR cases (bypass or non-bypass), cath lab, electrophysiology lab and/or general OR cases with patients w/ significant congenital heart disease with direct supervision from cardiac anesthesiologist
• Goals:
  • Demonstrate airway management, central line placement and arterial line placement with modifications as needed for patients with common congenital and acquired heart disease
  • Describe the effects of anesthesia medications on physiology in patients with complex congenital heart disease
  • Understand the physiologic effects of cardiopulmonary bypass

Interventional Cardiology (Cath)  (4 Weeks)

• Goals:
  • Justify different indications for cath interventions
  • Understand interpretations of pressure waveforms in different locations
  • Differentiate utility and limitations of pressure measurements and oxygen saturation measurements in different locations and cardiac anatomy
  • Utilize data from catheterization procedures to inform patient management in the CICU

Echo (4 weeks)

• Goals:
  • Learn how to interpret basic aspects of common echocardiographic views. Ex: Qualitative RV and LV function, qualitative valve function, presence or absence of effusion, basic assessment of aortic arch anatomy. 
  • Determine indications for and limitations of CT angiography and cardiac MRI in the assessment of congenital and acquired heart disease. Utilize this data in formulating plan of care for patients in the CICU.

Electrophysiology (2 Weeks)

• Round with inpatient EP service, participate in procedural cases in the EP lab, observe EP clinical procedures (stress test)
• Goals:
  • Diagnose and treat common tachyarrhythmias, including common classes of antiarrhythmic medications
  • Differentiate indications for different forms of pacemakers/defibrillators
  • Recognize indications for ablation and other specialized EP procedures
  • Recognize EKG and historical indications for testing for common genetic channelopathies

Heart Failure (Advanced Cardiac Therapeutics Team) (4 Weeks) 

• Round with team and participate in follow-up visits in the clinic.
• Goals:
  • Explain the main components of oral goal-directed medical therapy (GDMT) for heart failure including indications and limitations/side effects for each class of medications
  • Describe the indications for chronic IV inotrope therapy
  • Determine indications and contraindications for listing for heart transplantation
  • Break down the options for mechanical circulatory support in pediatric patients, including the advantages, disadvantages and limitations of each device
  • Summarize pos- transplant immunosuppression, including understanding of both antibody-mediated and cellular rejection as well as listing some options for treatment of these.