Timing is everything

The moment a patient arrives at the Peter Munk Cardiac Centre’s Coronary Intensive Care Unit, the countdown to save their life begins.

When the nurses in the Florence and Rueben Fenwick Coronary Intensive Care Unit (CICU) at University Health Network’s Peter Munk Cardiac Centre receive a code STEMI call, every moment matters.

A STEMI is a heart attack indicating the complete blockage of a coronary artery that requires immediate medical intervention as the heart muscle is currently dying. Administering treatment as fast as humanly possible is the best way to limit permanent heart muscle damage and improve chances of survival.

“Time is muscle,” explains Lindsay Love, Clinical Manager of the CICU. Timeliness is measured in seconds and minutes, not hours or days, and there’s no room for error as the highly skilled team begins rapid interventions to prepare the patient for the Dr. Susan Lenkei-Kerwin Catheterization Laboratory (Cath Lab) where the team removes the blockage.

Unlike an Intensive Care Unit (ICU), which cares for patients with a range of health issues, the CICU at the Peter Munk Cardiac Centre is a unique and specialized unit focused on providing best-in-class care for patients suffering from life-threatening heart conditions.

All hands on deck

There are many metaphors that can describe the technical elegance of the CICU team in action – an orchestra, a pit crew, a hockey team – but it is how the team gracefully moves together to save a life that is a true testament to their efficiency.

“Time is muscle.”

Lindsay Love

“We receive the patient, hook up monitors, position a ventilator, switch over the intra-aortic balloon pump from the ambulance to the University Health Network system, take blood samples, insert lines under fluoroscopy – a real-time video of the affected area using a series of x-rays – and get the right clinical team in the room to assess the patient as quickly as possible,” Love explains.

The CICU team is ready to rapidly assist with all hands on deck to employ life-saving therapies, as needed, and prepare the patient for treatment. On any given shift, the larger team consists of eight to 10 CICU nurses, a patient care assistant, residents who are training to be the next generation of cardiologists, an attending cardiologist, plus allied health staff such as respiratory, physio and occupational therapists as well as spiritual care practitioners.

“The team is proactive, responsible and adaptable in the most unpredictable situations.”

Dr. Adriana Luk

Acutely ill patients requiring coronary, electrophysiology or structural interventions can be treated for intervention by the cardiovascular team of surgeons in the Cardiac Surgery operating room or be brought into the Cath Lab across the hall from the CICU. Reimagined as a state-of-the-art facility in 2020, the Cath Lab is critical to treating a wide range of patients with complex heart disease, including angina, congenital heart disease, and heart attacks.

Monitors, scanners and imaging equipment give physicians, nurses and technicians a clear view of what is happening inside a patient’s heart during the procedure. And, while these technologies allow for more minimally invasive procedures and translate to safer and faster treatment with shorter patient recovery times, it is the team’s ability to assess and respond to the needs of each patient in an instant that sets the Peter Munk Cardiac Centre’s CICU team apart.

Maintaining perspective in a crisis-driven environment

There is no prescribed rhythm of how each week or day goes and the pace of the Peter Munk Cardiac Centre’s CICU can change in an instant. “There is indeed pressure to accomplish many tasks in a short time frame when a patient arrives in life-threatening distress,” describes Dr. Adriana Luk, intensivist and advanced heart failure and transplant cardiologist and head of the CICU at the Peter Munk Cardiac Centre.

Both Love and Susie Choi, the unit’s spiritual care practitioner, know the immense pressure the CICU team faces when a patient and their family grapple with the realities that a massive heart attack can bring. “A lot of processing takes place but there’s a relational aspect to making sense of the unanticipated challenges,” says Choi, speaking of both patient and team members’ encounters. “It’s such a specialized unit and my role is to provide support to whoever is in need of spiritual care,” says Choi.

“There is so much respect and support here. This unit exemplifies the word ‘teamwork’.”

Lindsay Love

Helping both the team and the patient navigate the pressure, Choi recognizes her role not as a job but as a calling. “Each patient is sacred. It’s not just medicalized but caring for the whole person. I’m so privileged to witness the incredible relational dynamic of this entire team. There is so much harnessed wisdom, all fueled by a familiar calling.”

This familiar calling translates into a collaborative team that Dr. Luk is proud of. “The CICU team is united in their work and will always work as a team to get the job done,” she boasts, especially when it comes to the incredible work the entire team delivers in such a crisis-driven environment. “The team is proactive, responsible and adaptable in the most unpredictable situations.”

“It can be anxiety-producing because we receive the sickest of the sick patients,” says Love as she describes what can happen when a patient arrives at the CICU. Despite immense pressure placed on the team to deliver rapid results and treatments, “It all runs so naturally. There is so much respect and support here. This unit exemplifies the word ‘teamwork’. ”