A 12-month deliberate practice roadmap for training a world-class cardiac intensivist
Hemodynamics, Fast-track pathways, CPB physiology. Reviewing Bojar's Manual; mastering the determinants of CO, SvO₂, and tissue oxygenation. Understanding CPB inflammatory cascades and ischemia-reperfusion injury.
CABG care, post-op ischemia, distributive shock. Differentiating cardiogenic from vasoplegic shock. Managing dual antiplatelet therapy post-stent and holding P2Y12 inhibitors perioperatively.
Aortic, Mitral, Tricuspid interventions. Understanding unmasked LV dysfunction post-AVR; managing paravalvular leaks, SAM post-mitral repair, and post-TAVR heart blocks.
Cardiac arrest post-cardiotomy, emergency resternotomy. Memorizing the CALS algorithm; practicing withholding compressions for pacing/defibrillation; utilizing 50-100mcg Epi boluses instead of 1mg.
Impella management, DanGer-SHOCK context. Analyzing Impella CP power levels and waveforms; monitoring for hemolysis, aortic regurgitation, and limb ischemia. IABP timing and triggering.
Refractory shock, ECLS-SHOCK context. Managing differential hypoxia (Harlequin syndrome); LV venting strategies; understanding ECMO mechanics and oxygenator function.
Durable LVAD/RVAD management, hematology. Troubleshooting VAD alarms (suction vs low flow); managing GI bleeding, acquired von Willebrand syndrome, and right heart failure post-implant.
Immunology, PGD, ISHLT Guidelines (2024). Applying precise PGD grading (Mild, Moderate, Severe); adjusting calcineurin inhibitors; managing denervated heart physiology.
Post-CPB bleeding, TEG/ROTEM interpretation, nosocomial infections. Interpreting viscoelastic tests to administer targeted cryoprecipitate, platelets, or prothrombin complex concentrates.
ACHD physiology, CRRT, ARDS, Ventilator weaning. Understanding Fontan circulation hemodynamics; managing fluid removal via CRRT without inducing hypovolemic shock.
TEE proficiency, stroke, delirium management. Conducting detailed neuro exams on intubated patients; managing targeted temperature protocols post-cardiac arrest.
Unit triage, Heart Team collaboration, Ethics, Quality Improvement. Leading multidisciplinary rounds; conducting formal M&M reviews; developing institutional protocols.
S.K.
The World-Class Cardiac Intensivist