Dolly Dholakia

Septic shock, liver failure, gastrointestinal hemorrhage, and other life-threatening disorders are becoming more common as people with severe health issues getting critical care treatment. Cardiologists must also be proficient in a range of techniques beyond what is commonly offered in their training, such as airway/ventilator control, in order to care for their patients. The need for a wider critical care medicine skill set has become much more apparent as a result of the COVID-19 pandemic. According to a new expert opinion piece published in the Journal of the American College of Cardiology, As the number of patients with multiple comorbidities in cardiac intensive care units (CICUs) rises, further critical care medicine training for interventional cardiologists is needed. The three co-authors, all cardiologists, advocate for the development and implementation of a new training pathway that incorporates interventional cardiology and critical care medicine into a single one-year fellowship. 

The authors point out that existing critical care pathways for interventional cardiologists emphasize instruction in the treatment of complex patients with heart failure and cardiogenic shock. As a result, they're mainly concerned with heart failure care, including temporary mechanical circulatory support systems, durable left ventricular assist devices, and heart transplantation, with less consistent coverage of airway/ventilator control and noncardiac critical illness. Furthermore, these options include two-year fellowship programmes, which can present psychological, logistical, and financial challenges to candidates.

The proposal recommends a one-year interventional intensivist fellowship that combines key interventional cardiologist skills with those required for noncardiac critical care, such as airway/ventilator control. Trainees will rotate through medical, neurologic, and cardiothoracic surgical ICUs, as well as anesthesia, as part of the proposed interventional intensivist pathway, before serving as junior attendings in the CICU.

After completing a comprehensive general cardiovascular training programme, completion of a committed critical care fellowship is the perfect way to gain critical care skills. This may be followed by a year of specialized training in a field such as heart failure or coronary intervention. Finally, mastery and special competence in the treatment of critically ill cardiac patients, as well as a willingness to spend a significant portion of one's career within the boundaries of a tertiary-care dedicated and closed cardiac intensive care unit, should be the priority. 

Nonetheless, it is clear that cardiologists working in CICUs today must improve their critical care medicine skills. “There are many directions that can be taken to better attain this information, and it is critical that we begin the conversation now on what those paths should look like.”