Jacob Chacko

Supervisor: Jennifer Conway

Project: Risk factors for re-admission to the intensive care unit for children supported on ventricular assist devices

Degree program:

Medicine & Dentistry-Pediatrics

Lay abstract:

Ventricular assist device (VAD) support is widely regarded as a treatment option for children with end-stage heart failure. A VAD is a type of mechanical circulatory support that helps or takes over the work of the heart. Improvements in device technology and medical management of these patients have yielded improved results such as reducing the need for extra-corporeal membrane oxygenation and its associated complications and reducing the transplant waiting list mortality in the most critically ill patients. However, use of VAD support in the pediatric population is not without complications, with the most common being device malfunction, clots, strokes, bleeding events and infections. The field has moved from managing these complex patients in the ICU till transplant to discharging patients to the ward and in some cases to home. Many of the complications that arise can cause significant morbidity and mortality with the need for increased resources including readmission to the intensive care unit. The Stollery Children's Hospital and University of Alberta Hospital have been utilizing various forms of VAD therapy since 2005 and therefore has one of the largest experiences in North America. This positions the Stollery Children's Hospital with a unique opportunity to further advance the field of VAD therapy in pediatric patients by sharing our experiences with the heart failure and VAD community. The objective of this project is to collect and analyze data regarding re-admission of pediatric patients on VAD support to the Pediatric Cardiac Intensive Care Unit (PCICU) at the Stollery Children's Hospital. The expected outcome of this research is a detailed analysis and presentation of PCICU re-admission cases with goal of gaining a deeper understanding of the risk factors associated with poor outcomes in children supported on VADs.

What motivated you to participate in this research?

When choosing a project this summer, I knew that I wanted to undertake research of a clinical nature as opposed to the pure lab-based research that I have done in the past. This particular project interests me for several reasons. Working not only in the field of cardiology (a pump-pipe based system) but also with mechanical assist devices provides a great fit with my engineering background. Furthermore, the project allows me to review records of patients in the pediatric intensive care unit, providing valuable clinical exposure including typical medications given, procedures performed, and jargon used. It also gives me the opportunity to work with a pediatric population, which may help open doors if I choose to pursue pediatrics as a career, while simultaneously providing exposure to internal and critical care medicine. Finally, my supervisor, Jennifer Conway, is a good teacher who allows me to work independently while providing support and guidance as needed.

What are your career aspirations?

Having finished only one of my first four years of medical school, all I can say with certainty is that I want to be a doctor. In almost every field of medicine there are aspects of the job that appeal to me, making more specific career decisions difficult. That being said, a medical specialty, particularly pediatrics, family, or internal medicine are currently at the top of my list. Regardless of the discipline, my goal will be to complement my practice with clinical research. I look forward to having a career where I can come across questions and then carry out research to help find an answer. I also enjoy teaching and hold education as extremely valuable. Therefore, I intend to incorporate an element of teaching in whatever specialty I decide to pursue.

How has this studentship helped you toward those aspirations?

Although I have participated in other research projects before, this is the first time that I have been directly involved in selecting variables with which to analyze our patient population. The identification and selection of these variables required me to undertake literature review, data collection, and study design, all of which have increased my ability to carry out research independently. Furthermore, since beginning my project I have poured over ICU records to acquire data for my patient population. Doing so has given me valuable insight into how critically ill patients are cared for at a tertiary centre. Reading through these records has also instilled in me the importance of taking good notes as a physician, a lesson that is likely underrated in terms of its benefits for my future career. Finally, it has given me a broad exposure to a range of medical disciplines, not only aiding my decision of which to pursue as a career, but hopefully also making me better equipped to get a residency in, and later thrive in my chosen career path.