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Cardio Update

Cross-disciplinary Collaboration, Around-the-Clock Nurse Practitioners Provide Consistent Care in ICU

As the population ages, the number of ICU beds and demand for intensivists is increasing, but these specially-trained physicians are in dramatically short supply.1 Over the last decade, the 30-bed Heart and Vascular Critical Care Unit (CCU) at Penn State Health Milton S. Hershey Medical Center has addressed this challenge with intensivist-led care teams that increasingly rely on nurse practitioners (NPs), while continuing to meet the complex needs of critically ill patients. Research suggests the model may confer a slight boost in ICU survival rates.2

The Heart and Vascular Institute plans to add one intensivist and five NPs to its current team of three intensivists and 11 NPs, according to Christoph Brehm, MD, and Angela Manoskey, CRNP.

This team manages the primary CCU service for all mechanical circulatory support patients, including those with left ventricular assist devices, total artificial hearts, and veno-arterial and veno-venous ECMOs. Intensivists evaluate these patients daily and oversee care plans created by a multidisciplinary team including fellows from cardiology, general surgery, anesthesia, infectious disease and pharmacy. Nurse practitioners, who are available 24/7, collaborate with the attending physicians on each patient’s care plan, execute it, perform all bedside procedures and manage acute care issues. Team members, who all have experience with mechanical circulatory support and ECMO patients, care for patients without bedside perfusionist coverage.

NPs enhance the care model by “bringing together the various disciplines to ensure the patients’ needs are identified and handled effectively. I can’t always talk to other specialists on every issue,” Dr. Brehm notes.

Heart and Vascular Institute Critical Care Unit NPs have at least two years of critical care ICU bedside experience; have completed a master’s prepared nurse practitioner program and are board-certified as acute care nurse practitioners. Before working independently, NPs participate in a four- to six-month orientation. “In most centers, this long period of orientation is unheard of, but we’re quite specialized and believe it’s time well spent to become competent to provide consistent care for this complex cohort of patients,” says Manoskey.

A head-and-shoulders photo of Christoph E. Brehm, MD

Christoph E. Brehm, MD

Assistant Professor, Surgery
Program Director, Heart and Vascular Critical Care Unit and Adult ECMO Program Intensivist
Phone: 717-531-7459
Residency: Cardiothoracic surgery, Ruhr-University Bochum, Bochum, North Rhine-Westphalia, Germany
Medical School: Faculty of Medicine – Phillips University of Marburg, Marburg, Germany
Connect with Christoph E. Brehm, MD, on Doximity

A head-and-shoulders photo of Angela M. Manoskey, CRNP

Angela M. Manoskey, CRNP

Nurse Practitioner
Phone: 800-243-1455
Graduate Study: MSN, Nurse Practitioner, Pennsylvania State University, University Park, Pa.
Connect with Division of Cardiology on Doximity


  1. Krell, K. (2008). Critical care workforce. Critical Care Medicine, 36(4); 1350–3.
  2. Accessed March 7, 2016.

Penn State Heart and Vascular Institute (PSHVI) is a national model for comprehensive heart and vascular care, research, and medical education. The Society of Thoracic Surgeons ranked PSHVI among the most elite programs in the nation, with a three-star rating. We serve as the only heart transplant center in central Pennsylvania, including artificial heart placement.

World-renowned doctors, skilled physician extenders, and Magnet-recognized nurses work together to provide advanced care for both common and complex heart and vascular conditions. PSHVI provides options for treating structural heart disease, including TVAR, Watchman and MitraClip, and delivers Joint Commission-accredited programs in advanced heart failure and implanting ventricular assist devices as a long-term treatment or as a bridge to heart transplant.

Our PSHVI physicians and scientists are committed to advancing the knowledge of causes and effects of cardiovascular disease through research and clinical trials and to training the physicians of the future.

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