Cardiac Surgery Intensive Care Unit at VCU Health
May 2022
Cardiac Surgery Intensive Care Unit
at VCU Health
Virginia Commonwealth University Health System VCU Medical Center
Richmond
,
VA
United States
Sherry Lockhart RN, MSN, CCRN
Christin Kim, MD
Maria “Dhol” Tuason BSN, RN, CCRN
Katie Burrow BSN, RN, CCRN
Caitlin Halpin BSN, RN, CCRN
Christin Kim, MD
Maria “Dhol” Tuason BSN, RN, CCRN
Katie Burrow BSN, RN, CCRN
Caitlin Halpin BSN, RN, CCRN
This past year has presented extraordinary challenges with COVID and the associated collateral damage. The Cardiac Surgery Intensive Care Unit (CSICU) nursing team has been a shining light; guiding those impacted to a place of reason, assisting with increased coping strategies, and providing solid support. Their deep understanding of the family unit has been demonstrated in compassionate efforts to maintain family involvement during restricted visitation guidelines and altered communication methods. The team has balanced the need for rule exceptions with the need to minimize exposures. They have looked beyond technology, never losing sight of the importance of the human touch. Because of this nursing team, an atmosphere of care, compassion, and empathy has prevailed during extraordinary times. This was never more evident than in the exemplar below.
Abby (name has been changed) was an otherwise healthy 27-year-old female. She had been feeling under the weather and fatigued for approximately a week. Her day began uneventfully with plans for a weekend girl’s trip after work with her mother and two sisters. In the late morning, Abby’s colleagues witnessed her lose consciousness and exhibit seizure-like activity. Emergency Medical Personnel arrived shortly thereafter and initiated Cardiopulmonary Resuscitation. EMS defibrillated her and brought her to VCU’s Emergency Department, where she had subsequent cardiac arrests. As a result, she was placed onto VA-ECMO, a life-sustaining cardiac bypass measure.
Within the CSICU, Dhol Tuason RN, received a call that an ECMO alert was underway in the ED. She assembled our nursing team in preparedness for this “rolling admission.” From her report, we learned Abby experienced multiple cardiac arrests with likely anoxic brain injury, suggesting a grim prognosis. Dhol assumed primary care and assigned multiple nurses to work in tandem, ensuring she was admitted safely to the unit. Once she arrived, a scurry of activity ensued. Labs were obtained, as nurse verifications were completed on medication dosages and infusion rates in a desperate attempt to achieve hemodynamic stability. With detailed accuracy, a nursing team member assumed documentation duties chronicling the critical events. Abby’s fragile body was all but lost in the intentional controlled chaos surrounding her.
Simultaneously, CSICU Nurse Manager, Sherry Lockhart, turned her attention to the family, ensuring frequent updates were provided to them. Sherry made accommodations for the safe and private reception of Abby’s condition in the CSICU family conference room. Nursing worked with the resident chaplain to provide emotional comfort and spiritual support to all involved. In conversations, we learned Abby’s mother and Abby herself worked at VCU. We quickly realized we were caring for “one of our own.”
Once her mother and two sisters were as prepared as possible, they were escorted to the bedside. Her sisters struggled terribly as their mother collapsed over top of Abby sobbing. Our nurses held and consoled them all. We cleared a path amongst the many devices allowing them to touch Abby, talk with her, and tell her how much they loved her.
Abby’s mother had but one request… to hold her daughter closely. In an unusual move given Abby’s criticality, Dhol never hesitated. She worked in coordination with the ECMO specialist to secure all life sustaining lines. She then assisted Abby’s mom to lay beside her child. Once there, mom softly whispered prayers, sang songs, and shared secret gestures only a mother and her daughter know. This would be a position she would often assume over the next two days.
Many critical events transpired in the ensuing hours and days. Abby was ruled COVID-negative. Her Glasgow Coma Scale Score necessitated LifeNet notification. She was emergently transported to the cath lab, where she went into complete heart block, and a pacemaker was placed. With each series of events, our nursing team was there to support, explain, and bring attempted comfort to this family. Abby’s neurologic prognosis worsened as her pupils became fixed and dilated and a CT of the head revealed irreversible anoxic brain injury. With this conclusive determination, Abby’s parents began discussing organ donation.
The nursing team assisted the family’s emotional transition from the initial shock, loss, and grief, to an eventual acceptance of organ donation. As we moved to the nighttime hours, Katie Burrow RN, worked closely with the family, supporting critical decisions of care and the seamless transition from acute care to palliative assistance. She became the family liaison with LifeNet, all while managing the many critical interventions needed to prepare for organ donation. Katie had a profound effect on them connecting on a personal level, sharing stories about her own family’s unexpected loss, grief, and their healing process.
Sherry connected well with Abby’s sisters. She spent time with them away from the bedside, where they were more comfortable sharing in a lifetime of “sister tales.” In accordance with visitation restrictions, she learned there was a large peer network (30 plus people) that had congregated outside atop the visitor parking deck. They had learned of Abby’s condition and plans for organ donation. They clung to the hope of participating in her Walk of Honor (a ceremonial event commemorating a patient prior to organ donation). Sherry expressed concern for their safety, as they stood vigil in the sweltering Richmond summer heat. The entire unit sprang into action and erected a tent to provide shade. Team members brought in cases of water, Gatorade, snacks, buckets of ice, and towels. The team understood and supported her peers' need to be present.
As wishes were finalized, a group of nurses gathered at the station making memory packages for Abby’s family. A special memory was created for dad with a lock of her curly brown hair. Abby’s fingerprints were carefully obtained and placed on cards in the shapes of hearts and butterflies. Perhaps most sacred of all, Dhol procured Abby’s last native cardiac rhythm telemetry strips prior to her pacemaker placement. These were placed in glass heart-shaped bottles and given to the family.
As time for organ procurement approached, plans for the Walk of Honor were made. Dr. Christin Kim, CSICU’s Medical Director, had overseen every clinical detail of this case, even securing an emergent procurement status, as Abby’s condition deteriorated. She promised this family, the team would see this through all the way to the OR. Mom, Dad, and both sisters wrote heartfelt letters to Abby. The Heart Center was notified of a 4pm Walk of Honor so they too could be present. Sherry worked with patient relations and the COVID clearance center to expedite the admission of the entire support group that stood vigil outside for 48 plus hours to honor Abby. With temperatures checked, masks in place, and hand hygiene done, she escorted each of them to the unit as the CSICU hallway was now lined along both sides with varied disciplines and nursing/physician colleagues from throughout the hospital… all present to honor Abby and the gift of life.
In a coordinated effort, Abby’s support team, led by her sisters, were stationed just outside her room. Our nursing team along with Dr. Kim, perfusion, anesthesia, respiratory, and LifeNet personnel slowly prepared her for travel. The team received notification that the organ donation flag had been hung outside the hospital. With Abby’s parents positioned by her sides, the Walk of Honor began. There was not a dry eye along the journey. Abby’s family escorted her to the sterile boundaries of the OR. Before they left, Dr. Kim asked mom for Abby’s favorite song. It was reported she had a love for Christmas music… perhaps “Silent Night” yet there was a tossup with “The Girl from Ipanema.”
After tearful goodbyes and as promised, Dr. Kim and Dhol stayed with Abby all the way into the OR. Before any procedure began, nursing read aloud the four letters written by Abby’s family. The chaplain read scripture the family had chosen to memorialize her. Dr. Kim streamed both “Silent Night” and “The Girl from Ipanema.” Realizing her work was done, Dhol gathered Abby’s blanket for her mom, as Abby slipped away to the sounds of Elvis Pressley’s Christmas album… yes Christmas in August for Abby.
In one of the saddest, yet most meaningful moments that our unit has experienced, we were all able to support an incredible family and celebrate the life of an amazing young woman. Cardiac Surgery nurses demonstrated "superpower" abilities managing the highest levels of critical illness and acuity, while providing high-level emotional support to this family and one other. They demonstrated care, compassion, and a palpable sense of empathy. They were authentic in facilitating a peaceful death with honor, dignity, and personalized memory preservation. They enabled the most extraordinary of successful outcomes… the integrity of a family’s wish to honor their loved one’s life in death. Because of the CSICU nursing team, Abby successfully gifted her organs to several patients in need and saved countless lives.
Abby (name has been changed) was an otherwise healthy 27-year-old female. She had been feeling under the weather and fatigued for approximately a week. Her day began uneventfully with plans for a weekend girl’s trip after work with her mother and two sisters. In the late morning, Abby’s colleagues witnessed her lose consciousness and exhibit seizure-like activity. Emergency Medical Personnel arrived shortly thereafter and initiated Cardiopulmonary Resuscitation. EMS defibrillated her and brought her to VCU’s Emergency Department, where she had subsequent cardiac arrests. As a result, she was placed onto VA-ECMO, a life-sustaining cardiac bypass measure.
Within the CSICU, Dhol Tuason RN, received a call that an ECMO alert was underway in the ED. She assembled our nursing team in preparedness for this “rolling admission.” From her report, we learned Abby experienced multiple cardiac arrests with likely anoxic brain injury, suggesting a grim prognosis. Dhol assumed primary care and assigned multiple nurses to work in tandem, ensuring she was admitted safely to the unit. Once she arrived, a scurry of activity ensued. Labs were obtained, as nurse verifications were completed on medication dosages and infusion rates in a desperate attempt to achieve hemodynamic stability. With detailed accuracy, a nursing team member assumed documentation duties chronicling the critical events. Abby’s fragile body was all but lost in the intentional controlled chaos surrounding her.
Simultaneously, CSICU Nurse Manager, Sherry Lockhart, turned her attention to the family, ensuring frequent updates were provided to them. Sherry made accommodations for the safe and private reception of Abby’s condition in the CSICU family conference room. Nursing worked with the resident chaplain to provide emotional comfort and spiritual support to all involved. In conversations, we learned Abby’s mother and Abby herself worked at VCU. We quickly realized we were caring for “one of our own.”
Once her mother and two sisters were as prepared as possible, they were escorted to the bedside. Her sisters struggled terribly as their mother collapsed over top of Abby sobbing. Our nurses held and consoled them all. We cleared a path amongst the many devices allowing them to touch Abby, talk with her, and tell her how much they loved her.
Abby’s mother had but one request… to hold her daughter closely. In an unusual move given Abby’s criticality, Dhol never hesitated. She worked in coordination with the ECMO specialist to secure all life sustaining lines. She then assisted Abby’s mom to lay beside her child. Once there, mom softly whispered prayers, sang songs, and shared secret gestures only a mother and her daughter know. This would be a position she would often assume over the next two days.
Many critical events transpired in the ensuing hours and days. Abby was ruled COVID-negative. Her Glasgow Coma Scale Score necessitated LifeNet notification. She was emergently transported to the cath lab, where she went into complete heart block, and a pacemaker was placed. With each series of events, our nursing team was there to support, explain, and bring attempted comfort to this family. Abby’s neurologic prognosis worsened as her pupils became fixed and dilated and a CT of the head revealed irreversible anoxic brain injury. With this conclusive determination, Abby’s parents began discussing organ donation.
The nursing team assisted the family’s emotional transition from the initial shock, loss, and grief, to an eventual acceptance of organ donation. As we moved to the nighttime hours, Katie Burrow RN, worked closely with the family, supporting critical decisions of care and the seamless transition from acute care to palliative assistance. She became the family liaison with LifeNet, all while managing the many critical interventions needed to prepare for organ donation. Katie had a profound effect on them connecting on a personal level, sharing stories about her own family’s unexpected loss, grief, and their healing process.
Sherry connected well with Abby’s sisters. She spent time with them away from the bedside, where they were more comfortable sharing in a lifetime of “sister tales.” In accordance with visitation restrictions, she learned there was a large peer network (30 plus people) that had congregated outside atop the visitor parking deck. They had learned of Abby’s condition and plans for organ donation. They clung to the hope of participating in her Walk of Honor (a ceremonial event commemorating a patient prior to organ donation). Sherry expressed concern for their safety, as they stood vigil in the sweltering Richmond summer heat. The entire unit sprang into action and erected a tent to provide shade. Team members brought in cases of water, Gatorade, snacks, buckets of ice, and towels. The team understood and supported her peers' need to be present.
As wishes were finalized, a group of nurses gathered at the station making memory packages for Abby’s family. A special memory was created for dad with a lock of her curly brown hair. Abby’s fingerprints were carefully obtained and placed on cards in the shapes of hearts and butterflies. Perhaps most sacred of all, Dhol procured Abby’s last native cardiac rhythm telemetry strips prior to her pacemaker placement. These were placed in glass heart-shaped bottles and given to the family.
As time for organ procurement approached, plans for the Walk of Honor were made. Dr. Christin Kim, CSICU’s Medical Director, had overseen every clinical detail of this case, even securing an emergent procurement status, as Abby’s condition deteriorated. She promised this family, the team would see this through all the way to the OR. Mom, Dad, and both sisters wrote heartfelt letters to Abby. The Heart Center was notified of a 4pm Walk of Honor so they too could be present. Sherry worked with patient relations and the COVID clearance center to expedite the admission of the entire support group that stood vigil outside for 48 plus hours to honor Abby. With temperatures checked, masks in place, and hand hygiene done, she escorted each of them to the unit as the CSICU hallway was now lined along both sides with varied disciplines and nursing/physician colleagues from throughout the hospital… all present to honor Abby and the gift of life.
In a coordinated effort, Abby’s support team, led by her sisters, were stationed just outside her room. Our nursing team along with Dr. Kim, perfusion, anesthesia, respiratory, and LifeNet personnel slowly prepared her for travel. The team received notification that the organ donation flag had been hung outside the hospital. With Abby’s parents positioned by her sides, the Walk of Honor began. There was not a dry eye along the journey. Abby’s family escorted her to the sterile boundaries of the OR. Before they left, Dr. Kim asked mom for Abby’s favorite song. It was reported she had a love for Christmas music… perhaps “Silent Night” yet there was a tossup with “The Girl from Ipanema.”
After tearful goodbyes and as promised, Dr. Kim and Dhol stayed with Abby all the way into the OR. Before any procedure began, nursing read aloud the four letters written by Abby’s family. The chaplain read scripture the family had chosen to memorialize her. Dr. Kim streamed both “Silent Night” and “The Girl from Ipanema.” Realizing her work was done, Dhol gathered Abby’s blanket for her mom, as Abby slipped away to the sounds of Elvis Pressley’s Christmas album… yes Christmas in August for Abby.
In one of the saddest, yet most meaningful moments that our unit has experienced, we were all able to support an incredible family and celebrate the life of an amazing young woman. Cardiac Surgery nurses demonstrated "superpower" abilities managing the highest levels of critical illness and acuity, while providing high-level emotional support to this family and one other. They demonstrated care, compassion, and a palpable sense of empathy. They were authentic in facilitating a peaceful death with honor, dignity, and personalized memory preservation. They enabled the most extraordinary of successful outcomes… the integrity of a family’s wish to honor their loved one’s life in death. Because of the CSICU nursing team, Abby successfully gifted her organs to several patients in need and saved countless lives.