Harefield Anaesthesia and
Intensive Care Unit

This would be a 1-year attachment in the Department of Anaesthesia and Critical Care and is most suited to the trainee aspiring to a career in cardiac or cardiothoracic anaesthesia. Over the year, the trainee would spend 2 durations, each of 6 weeks, in the Cardiac ICU. The trainee would be able to complete the SIAs in Cardiac and Thoracic anaesthesia within the year. Harefield is a tertiary adult cardiothoracic centre specialising in complex cardiac and thoracic surgery, including heart and lung transplantation, ventricular assist devices as well as a VA- and VV-ECMO programme. Minimal access cardiac surgery, mitral valve surgery and complex aortic surgery, including a dissection service, provide additional training opportunities. We have a primary PCI service with one of the fastest ‘door to procedure’ rates in the country and Harefield has one of the largest percutaneous tumour ablation services in Europe. Interventional cardiology services include arrhythmia ablations, PFO closures, TAVIs, MitraClips and complex devices such as ICDs. There is an active pre-assessment, optimisation and perioperative medicine programme for cardiac surgery with plenty of QI project potential. Trainees can expect an extremely interesting educational attachment with a high level of consultant support, with opportunities to gain experience in advanced cardiac output monitoring, as well as developing skills in transoesophageal echo. This is a very approachable department, as is consistently borne out by our trainee feedback. We have a rich and diverse teaching programme which is very much consultant led, as well as a new education centre with simulation models and a TOE simulator, including the option of simulating pathology, for more advanced practitioners. We have a body of in-trust 'human factor' course instructors, aimed at increasing the non-technical skills required in a multi-disciplinary team complex environment. Regarding cardiac anaesthesia, the placement would provide training in -anaesthesia for on- and off-pump CABGs, AVRs and combined procedures with decreasing levels of supervision -anaesthesia for complex valve surgery and aortic surgery -preoperative assessment and post-operative management in the 7-bed recovery unit or in the Cardiac ICU -perioperative management of patients with poor ventricular function -anaesthesia for emergency and elective interventional cardiology, including TAVIs, cardiac electrophysiology and complex devices -trans-oesophageal echocardiography, with regular training for the EACVI examination and support with building a logbook towards accreditation -anaesthesia for heart and lung transplantation; with > 80 transplants/year in the hospital there is a great opportunity to gain experience of transplantation as well as post-operative care and mechanical support modalities, including Impellas, VADs and ECMO Thoracic anaesthesia experience would include -anaesthesia for VATS, thoracotomies and other thoracic procedures -perioperative pain management for thoracic surgical patients -perioperative management of patients with recurrent pneumothoraces -managing patients for tracheal stents and tumour debulking, including transbronchial procedures Trainees can engage in the very active teaching programme offered by the Department, including -Physiology teaching (Mondays) -TOE teaching (Tuesdays) -Perioperative teaching (Wednesdays) -Journal Club (Wednesdays / Fridays) -ICU Grand Rounds (Thursdays) -CALS training sessions -Monthly clinical governance meetings -Quarterly formal TOE simulation sessions and the option to use the simulator at other times Trainees are supported and encouraged to complete quality improvement studies and to work on research projects in the Department. Summary: We offer all the experience required in the 2021 RCoA curriculum, but also the chance to really become familiar with complex cardiac cases, heart and lung transplantation and mechanical support in a highly supportive and enthusiastic environment. We have a very active teaching programme and lots of opportunities to be involved in teaching, clinical projects and quality improvement. Unit Supervisor – Dr Ben Silverman (ben.silverman@nhs.net)

Harefield hospital is a fascinating place to work. Critically unwell patients with severe cardiac disease are extremely challenging to care for and can deteriorate quickly with multisystem problems. A post here would give you experience in ECMO, transplant, mechanical circulatory support, cardiogenic shock and cardiac arrest management. The intensive care consultant team are all experts in cardiac ITU, extracorporeal life support and echocardiography and mentor all trainees to help them gain these skills. The critical care is staffed by a dedicated team of substantive medical, nursing and allied health professionals who rotate between the units. The care is enhanced with microbiology and radiology rounds as well as a weekly multi-disciplinary meeting where complex long stay patients are discussed. Echocardiography is a routine part of the daily practice. The unit has high quality machines capable of performing complete studies including 3D and speckle tracking. Trainees can be mentored through FEEL / FICE certification or through full BSE echo accreditation according to their experience and requirements. The department has a strong culture of safety and governance with opportunities to attend meetings, undertake quality improvement projects and take part in educational roles for junior doctors and medical students.

We welcome trainees who have special interest in echocardiography. We provide world-class education and training in point of care ultrasound (POCUS) at the Critical Care Unit at Harefield Hospital. We offer state of the art ultrasound equipment and world-renowned faculty of experts in basic to advanced echocardiography, and cardiac, lung, systemic venous POCUS. We are passionate about POCUS applications in ECMO and Mechanical Circulatory Support as well as, Ventricular Assist Devices and Heart and Lung Transplantation. We supervise trainees for all levels of national and international accreditation in echocardiography (FUSIC, EDEC, American National Board of Echocardiography and EACVI). The programme is led by a group of experts: Dr Hatem Soliman Aboumarie - consultant cardiothoracic intensivist. Member of the Board and Echocardiography Councillor at the European Association of Cardiovascular Imaging (EACVI) Dr Nick Lees – consultant cardiothoracic anaesthetist and intensivist and the lead for ICU echocardiography. An expert in TTE and TOE. Dr Efie Galiatsou – consultant cardiothoracic intensivist and an expert in TTE and TOE.

We are able to offer various fellowships depending on your level of experience, your interests and needs. Please contact us for more information.