Cardiac Intensive Care

The CICU consists of 16 beds in the West Wing of Southampton General Hospital and steps down to a large CHDU across the courtyard. There is a highly capable intensive care team headed up by Michaela Jones who is Matron for CICU and Dr Andy Curry who is clinical lead for CICU

Daily reviews

CICU is now a paper free unit. Documentation is via the MetaVision application. Whilst it is very appealing for senior trainees to write free text when performing daily patient reviews, it is important that this is done using the ‘daily review’ tab. This is important for auditing a variety of essential ICU tasks; VTE prophylaxis, acid prophylaxis, and so on. A full description of how to use Metavision is beyond the scope of this document but there is an extensive VLE which is important for all Wessex trainees to complete during their time in Southampton

Anaesthetic Immediate Responder (AIR) role

During your CICU shifts you may be notified by the general anaesthetic co-ordinator to request that you adopt the AIR role. This means that all other general anaesthetists are, or will be, involved in direct care and you would be expected to respond to an anaesthetic emergency (acting as the n+1 anaesthetist) if one arises. If you are required to leave CICU to fulfil this role then the relevant consultant for the area you are going to cover should be en-route to relieve you of this role within 30 minutes. Please keep a record of all requests to act as AIR (even if you are not required to leave CICU) in the book held at the ward clerk’s desk on CICU blue end.

Protocol for catheter lab (emergency PCI) patients

Patients presenting with unstable coronary syndromes or out-of-hospital cardiac arrest may involve shared care between the GICU and CICU. The protocol for management of these patients is clearly outlined on pages 99 to 100 of the CICU manual. In short if an IABP is sited, then the patient should be cared for in CICU  post-procedure otherwise the patient remains a GICU patient. Please ensure you are familiar with the protocol to avoid any delay in treating these time-critical patients

‘Fast-track’ patients (FT)

Up to 3 patients per day may be designated ‘Fast track’ and denoted as FT on the operating lists. The intention with these patients is that if surgery is uncomplicated they will bypass CICU and go directly to high-care for short term ventilatory support and managed in a nurse-led environment with support from the junior cardiothoracic surgeons and the CICU anaesthetists. In theory this may be for up to 24 hours but in reality, if successful extubation has not occurred before midnight the patient is usually transferred to CICU in exchange for a Level 2 patient. The CICU anaesthetist will be contacted for advice on ventilatory management and to supervise extubation. Please attend promptly when asked to assist with extubation

Role of the CICU clinical fellows

Whilst working in CICU you will overlap with the clinical fellows, the vast majority of whom are internationally trained anaesthetists. They are engaged in a parallel training programme of either one or two years and many are part of the European Association of Cardio-Thoracic Anaesthetists (EACTA) fellowship training (our unit is one of only a handful in Europe recognised for such training). You have the same roles and responsibilities in terms of patient care and communication with the CICU team and on-call consultants and daily work should be divided equally. Use each other’s skills and experience wisely; the STs will usually have a good idea of how the hospital as a whole functions and know the best channels of communication, the fellows may well have significant amounts of cardiac experience and knowledge of local CICU practice