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The Pediatric Cardiology Department is organizing conference entitled “Perioperative Management of Congenital Heart Disease” at the Amrita Institute of Medical Sciences, Cochin, Kerala on June 7 -9, 2019.

Venue: Amrita Institute of Medical Sciences, Cochin, Kerala

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About Partner Institutions

Children’s Heart Link (NGO)

Children’s HeartLink (CH) is a non-governmental organization based in Minnesota, USA dedicated to developing sustainable programs to prevent and treat children’s heart disease globally in the underserved areas. It empowers volunteer medical personnel from leading institutions to change lives worldwide. Now in its 40th year, CH partners with hospitals in India, China, Ukraine, Vietnam, Malaysia, South Africa, Kenya and Brazil.…

Pediatric Cardiac Society of India

The PCSI was among the first few societies of paediatric cardiology established in 1999. During the last two decades, they have grown into one of the prominent societies for paediatric cardiology leading academic activities across India and in running a world class journal ‘Annals of paediatric cardiology’. The Vision of the society is to be one of the ten best academic societies for Paediatric Cardiology in the world.

Their Mission is to facilitate the provision of equitable high quality healthcare to children with heart disease in India through world-class excellence in education, academic activities, research, and advocacy.

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Pediatric Cardiac Intensive Care Society, USA

PCICS was formed to provide an international professional forum for promoting excellence in pediatric cardiac critical care. The founders of the society launched their inaugural membership campaign in 2003. By the end of 2005, they had held their first symposium. They have grown to more than 1100 members in 44 countries. Their members are healthcare professionals dedicated to promoting scientific inquiry, acquiring knowledge and improving practice for their critically ill pediatric patients with congenital and acquired heart disease.

National Health Mission, Kerala (Hridyam)

This is a web based solution for system management of care of children with Congenital Heart Disease (CHD). This can be used as web based registry for CHD cases across Kerala, monitoring the progress of program envisaged for management of children with CHD, identify the bottlenecks for implementing the protocols established at any point, understand the case status and response time for systems in place and ultimately the outcome of the program

  • Preoperative stabilization and transport
  • Nursing Skllls Core Conference: June 8,9, 2019
  • Focus on challenges in paediatric heart care in Low and Middle Income Countries
  • Thoroughly interactive
  • A number of Real life Case Scenarios
  • Out standing International and regional faculty

It is increasingly apparent that pediatric heart conditions contribute substantially to Infant and childhood mortality In man~ tow and middle Income countries (LMICs). Perioperative Intensive care is critical to ensuring good outcomes in children with heart disease. This conference is especially designed for physician and nursing staff In LMICs recognizing the challenges they face in caring for babies with heart disease. The world’s leading experts from institutions that have established highest standards of care will interact with local and regional experts in a unique format that is carefully designed to maximize education and directly impact outcomes.


International Faculty

  • Lara Shekerdemian MD, Section Head, Cardiac Intensive Care, Texas Children’s Hospital
  • Ravi Thlagarajan MD,Chief.CICU,Children’s Hospital, Boston
  • Venkat Shankar, MD, MBA. Medical Director. CICU, Associate Division Chief, Division of Cardiac Critical Care,Children’s Hospital of Phlladelphla
  • Micheai·AIice Mega, MD, MSc, Department of Critical Care Medicine- Division of Cardiac Critical Care, The Hospital for Sick Children, Toronto
  • Sandy Staveski, RN PhD, University of California, San Francisco
  • David S. Cooper, MD, MPH, Medical Director, Cardiac Intensive Care Unit, Cincinnati Children’s Hospital Medical Center
  • Justine Fortkiewicz, RN, Children’s National, Washington

Regional Faculty

  • Senior physician and nursing stall members from pediatric heart programs in India and the Asia Pacific Region

Host Faculty

  • AIMS Pediatric Cardiac Physician and Nursing Staff
Program Plan

Preconference Workshop (Friday June 7, 8.l0 AM – 5.3O PM)

  1. ECMO/ECLS in pediatric cardiac perioperatlve care: Basic workshop focusing on basics with a view to promote efficient and appropriate use adapted to low resource settings to maximize potential benefits. Single day workshop limited to about SO participants from established pediatric heart programs in the region
  2. Preoperative stabilization and transport of neonates and infants with congenital heart disease: Target audience will include neonatologists and pediatricians from Kerala and neighboring states.
  3. A skill session workshop for nurses
  4. Building systems towards a sustainable workforce for PCICUs in low and Middle income Countries: Around table discussion

Main Conference (Saturday, June 8 and Sunday, June 9; 9.00 AM – 5.30 PM)

  1. Symposia
    • Ventilatorv management after congenital heart surgery
    • Sepsis, Infection cont rol and antibiotic stewardship
    • Postoperative arrhythmias· approach to diagnosis and management
    • Nutrition · enteral and parenteral
    • Prolonged stay in the pediatric cardiac ICU-Systematic approach
    • Perioperative cardiac pharmacology-a review of the evidence
    • Cost reduction strategies :
      • Fast tracked pediatric cardiac care: who gets II, what Is needed to implement?
      • Blood product management after pediatric cardiac surgery
  2. Critical thinking: Illustrative case scenarios on situations identified by nurses
  3. Challenging Case Scenarios
    • OR surprises
    • Catheter Intervention in the early postoperative period
    • Airway challenges
    • Unresolved lung issues
    • Miscellaneous challenges

Registration Closed

Program Partners

Program Schedule

Day 1

Day 1 – June – 7, 2019

Venue: Amrita Institute of Medical Sciences, Cochin

Time Title of the Session Contents Title of Talk Duration (Min) Presentator (Name, Institution) Session Moderator Panelists
9.00 AM Physiological Considerations Illustrative talks for a general audience. Single ventricle physiology 12+3 Rema Devi (MIMS Kozhikode) R. Suresh Kumar Venkat Shankar,
Dr. Purushotaman
Duct-dependent systemic circulation 12+3 Edwin Francis (Lissie)
Duct dependent pulmonary circulation 12+3 Navaneetha Sasikumar (MCH Kottayam)
Transposition 12+3 Arun Gopalakrishnan (SCT)
10.00 AM Comprehensive preoperative evaluation Introductory talks Introductory talks 12+3 Renu Kurup (MIMS Kozhikode) Mahesh K Lara Shekerdemian,
Dr. Febi,
Suresh Kumar,
Parvathi, Iyer
Clues to underlying genetic syndromes in neonates with heart disease 15+5 Sheela Nampoothiri (AIMS, Cochin)
Ruling out sepsis 15+5 AIMS Neonatology
Comprehensive checklist 5 min Mahesh to summarize
11.00 – 11.30 AM Tea Break
11.30 – 1.00 PM Preoperative stablization Learning through Illustrative Cases Left to right shunt with pneumonia: Simple (VSD) 10+5 Presentor from AIMS/other institutions Mahesh K Soo Kok Wai,
Lara Shekerdemian,
K.K Diwakar,
Vishal Singh,
Dr. Sheeja (SAT),
Dr. Jayashree (AIMS)
Left to right shunt with pneumonia: Complex (AVSD/multiple VSD) 10+5 Presentor from AIMS/other institutions
Duct dependent systemic circulation with end organ injury 10+5 Presentor from AIMS/other institutions
Preoperative sepsis in a newborn 10+5 Presentor from AIMS/other institutions
Obstructed TAPVC 10+5 Presentor from AIMS/other institutions
TGA: Septostomy? Prostaglandin? Direct ASO 10+5 AIMS data: Praveen Reddy
1.00  – 2.00 PM Lunch
2.00 PM Key ICU Procedures Lectures from experts High-risk intubation; how to make it safer 20+5 Suchitra Ranjith (Appolo Chennai) Jesin Jaishankar
2.25 PM Peripheral, central and arterial lines, Tips and tricks 20+5 Suresh G Nair (Aster Cochin)
2.50 PM Preoperative mechanical Ventilation: Key consideratons Brief  introduction 10 Rakhi B Suresh G Nair Parvathy Iyer,
Suchithra Ranjit,
Vijay Kumar (NICU-Kottayam),
Leela Kamath (Kolenchery)
2. 10 PM Interactive discussion with audience on  4-5 different condtions 40
3.40 PM When do we say no to surgery? Where do we draw a line and why? Key considerations 12+3 Balu Vaidyanathan Balu Vaidyanathan Renu Kurup,
Sivakumar Sivalingam,
Charu Singh,
Lara Shekerdemian
3.55 PM Illustrative case demonstrating specific challenges; parental perspectives Illustrative case 10+5 Pragnatha
4.10 PM Session Closed
Time Title Method Description / Details Length (min) Facilitator # groups
8:30-9:00 AM Registration Participant registration, seating 30 Local support
9:00-9:10 AM Introduction Review learning objectives, course outline, introduce faculty 10 Aveek + MAM 1
9:10-9:30 AM ECMO-a Primer Mini-lecture Brief review of indications, general principles, and circuit “anatomy” 20 TBD 1
9:30-10:00 AM ECMO in an Envelope Tabletop Participants “assemble” their 2D ECMO circuit and discuss components and set up with facilitator. 30 All 10
10:00-10:15 AM ECMO in a Bag Tabletop facilitated exercise Tables combine and assemble ECMO in a bag followed by labelling key circuit components with sticky notes 15 All 5
10:15-10:30 AM Check-In Large group discussion Participant questions and intro to rotating activity 15 1
10:30-10:45 AM Break Tea, refreshments 15 1
10:45-12:15 PM Around and around we go 3 stations noted below, participants rotate amongst stations. Each station takes 30min 90 All 3
1-Uncanny cannulas Interactive Demo Show selection of cannulas, cannulae tables and brief overview of cannulation-based ECMO nomenclature
2-The Real Thing Interactive Demo Participants “tour” a fully assembled, wet circuit and label circuit components
3-Here we go Interactive Demo and table top Step-by step guide to cannulating and establishing flow. Participants are given individual steps and are expected to put them in order.
12:15 – 13:00 PM Lunch
13:00-13:15 PM Review Large group Large group sharing  of lessons learned and preview of afternoon plans 15 MAM, Aveek
13:15-13:25 PM ECMO in an Envelope Sm group competition Timed competition. Correctly reassemble 2D tabletop circuits with ECMO in an envelope. 10 All 10
13:25-13:45 PM Go With the Flow Small group exercise Participants label tabletop circuits with flows and pressure measurements.  Once successfully completed, match ECMO terms to human physiologic measurements 20 All 10
13:45-14:00 PM ECMO as the Patient Mini-lecture Lecture introducing a physiologic framework for “diagnosing” ECMO problems and troubleshooting emergencies 15 TBD 1
14:00-14:30 PM Create the table Tabletop Small groups work together to create a table of physiologic changes seen with different ECLS problems 30 All 10
Small group
14:30-14:45 PM Check-In Large group Questions re: framework, clarification as needed. 15 MAM 1
14:45-15:00 PM Break Tea, refreshments
15:00-15:30 PM Diagnose it! Small group Utilizing tabletop models, learners are given sets of physiologic changes and need to identify the underlying problem 30 All 10
15:30-16:00 PM Special Patients, Special Circuits, Special Problems Interactive lecture Tricks of the trade for ECLS cannulation and support strategies for children with altered circulations 30 TBD 1
16:00-16:45 PM The Who and the How Expert panel Facilitated expert panel and audience discussion regarding the logistics and challenges of establishing and maintaining an ECMO program in low 45 Aveek (facilitator) local+international experts 1
16:45-17:00 PM Wrap It Up Large group Recap of the day, final thoughts, course evaluation 15 All 1

June 7, 2019 Meeting Followed by Faculty Dinner: Building Systems Towards a Sustainable Workforce for PCICUs in Low and Middle Income Countie

4:30 PM Meeting;  Building systems towards a sustainable workforce for PCICUs in low and Middle Income Counties Defining the problem: Workforce and Training Data from LMICs Defining the problem: Workforce and Training Data from LMICs: Physician  and nursing Staff 30 min ICU representatives from Vietnam, Sri Lanka, Malaysia, Bangladesh and ; Indian data to be presented by Jigar Surti Session Moderated by Bistra Zheleva Sandy Staveski, Suresh G Rao, Snehal Kulkarni, Sunita Maheshwari, Jigar Surti, Aveek Jayant, Vishal Singh, Parvathy Iyer Present and learn from examples of PCICU training that meets patient and/or population needs; present 1-2 innovative approaches for meeting the demand.
5:00 PM Learning from Examples Existing models from established programs in high income nations 10 min Ravi Thiagarajan
The nurse residency program at AIMS 10 min Vaisak/Saibala
IJN Nurse mentor program 10 min Karpagam
The CHL fellowship 10 min Bistra/KK
5.45 PM Envisioning Future Education Opportunities for PCICU Professionals Brainstorming on ideas for the future 70  min Objective: explore options for building the next generation of PCICU professionals and educators. Explore creative solutions, without compromising on quality of education and patient outcomes.
7.20 PM Wrapping up 10 min Bistra Questions to discuss:

  1. What are pipeline opportunities for attracting/developing future PCICU professionals?
  2. What core skills are needed?
  3. Are there shortcuts we can take to increase the access to care forward?
    • Using technology
    • legal and scope of practice issues
    • Selecting training institutions
  4. What professional societies should be engaged?
Day 2

Day 2 – June 8, 2019

Time Title of the Session Contents Title of Talk Duration (Min) Presentator (Name; Institution) Session Moderator Panelists Other Related Specifics
9.00 AM Welcome and Lamp lighting
9.15 AM Ventilatory management after congenital heart surgery Two talks and 2-3 cases Core Principles of Post operative ventilatory management 20 Venkat Shankar; CHOP Aveek Jayant Lara Shekerdemian, Shankar Kadam, Sujatha (MIMS) Sunil PR (Chitra); Ritujyoti RTIICS); Vaisakh G (AIMS) Lecture; discussion will be integrated with cases
9.35 AM Non invasive ventilation: Who needs it, who does not, how is it practiced? 15 Suchitra Ranjith, Appolo Chennai Lecture; discussion will be integrated with cases
9.50 AM Case presentations 40 Participating Institutions 2-3 cases from regional institutes illustrating  specific challenges in post operative ventilation of CHD patients; one case should include non-invasive ventilation.  What was the challenge?  How did we manage?  What could be done diffrerently?
10.30-11.00 AM Tea Break
11.00 AM Post -operative arrhythmias One introductory talk and 2-3 cases Sytematic approach to post-operative rhythm disturbances 15 Maniram, AIMS Cochin KK KU Natarajan, Ravi Thiagarajan Lecture outlining core principles of post operatrive arrhythmia management
11.15 AM Case presentations 45 Balaganesh / Farooq 2-3 illustrative cases from regional institutes; JET, Re-entrant arrhythmia, AV disociation, Others
12.00 Noon Sepsis, infection control and antibiotic stewardship Talks , Panels, Data from centers Real life challenges: Three perspectives- Bedside nurse, Charge Nurse and infection control nurse 25 Ashely, Reshma  and Athira KS (AIMS, Cochin) Dr. Sanjeev Singh Parvathy Iyer, Shobha (GKNM); HMD Hawegeegana; Saibala (AIMS) Brief presentations from each of the identified nurses
12.15 PM Innovative approaches to infection control in PCICU setting 15 Justine Fortkiewicz/Sandy Staveski
12.40 PM Infection control experiences from selected ICU environments in LMICs 30 IJN, RTIICS, KDA, Other institutions, AIMS Serial data from the last 3-4 years, specific challenges how they were overcome.  AIMS to serve as back up in the event one centre drops out.  7 min presentations and remaining time (9 min) for discussion.
1.00 PM Antibiotic stewardship: How to make it work? 20 Ramasubramanian, Appolo Chennai 15+ 5 for discussion
1.30-2.015 PM LUNCH
2.15-3.15 PM Challenging case Scenarios- Part 1 Cases from various institutions OR surprises 20 ICU staff AIMS/Other programs Shivaprakasha Soo Kok Wai, Sivakumar Sivalingam, Kamlesh Tailor, Jeril, Kanagarajan, Nagarajan Illustrative case where an unexpected challenge in the OR changes the course of operation
Airway challenges 20 ICU staff from AIMS/Other programs Illustrative case of a significant airway related problem in association with congenital heart surgery
Miscellaneous 20 ICU staff from AIMS/Other programs Any other unexpected challenge not ususally encountered
3.15-4.15 PM Critical thinking by the bedside nurse Case vignettes from various institutions Illustrative Case Scenarios in Situations Identified by Nurses 60 Nursing staff AIMS/Other programs Parvathy Iyer Justine Fortkeiwickz, Saibala, Shyla Suratkal, Karpagam, Lara Shekerdemian, Ravi Thiagarajan, Sudhatmaja
4.15 PM Tea Break
4.40 PM ECMO Roundtable Panel Discussion A perspective on ECMO use in  low resource settings: is the world really flat? 50 min Program will include one or two illustrative cases if available Aveek Jayanth Suresh G Rao, K Shivaprakasha, Brijesh Kotayil, Sandeep Chauhan, Micheal-Alice Moga Panel discussion on contentious issues in relation to use of ECMO in low resource settings
5.30 PM Sessions Close
Day 3

Day 3 – June 9, 2019

Time Title of the Session Contents Title of Talk Duration (Min) Presentator (Name; Institution) Session Moderator Panelists Other Related Specifics
9.00 AM Perioperative cardiac pharmacology-a review of the evidence Brief summary of evidence on commonly used medications in the ICU Introduction 10 Micheal Alice Moga Aveek Jayant: Asha, Sree lakshmi, Sreeja, Balaganesh, (AIMS) Two chithra PGs Meena Trehan, Vilson, Kishore, Snigdha, Unni KP, Sandeep Chauhan Succinct summary of available evidence about useful and harmfiul effects with recommendations
9.10 AM Dobutamine  8+2  
9.20 AM Levosimendan 8+2  
9.30 AM Milrinone 8+2  
9.40 AM Phenoxybenzamine 8+2  
9.50 AM Nitric oxide and sildenafil 8+2 Shine Kumar
10.00 AM Thyroxine 8+2  
10.10 AM Vasopressin 8+2  
10.20 AM Summing up _Discussion 10

Micheal Alice Moga

10.30 AM Challenging Scenarios #2 Case presentations on challenging scenarios Cardiac cathterization early after cardiac surgery 15 min AIMS/  (Balaganesh to present) Mahesh Ravi Thiagarajan, Edwin,  Jigar  Illustrative cases
  “Lung issues” 15 min AIMS/Other institutions 
11.00-11.30 AM Tea Break
11.30-12.45 PM Nutrition Lectures and cases Overview of principles 15 min Rakhi Balachandran Parvathy Iyer Sandy Staveski, Vinay Joshi, Vishal Singh,  Julie Chauhan (AIIMS Delhi); Nivedita (AIMS)  
Results of the prospective study from AIMS 7+3  Nayan Banerjee    
Parenteral nutrition in the LMIC setting 15+5 min Invited expert    
Three Illustrative cases 30 min Nurses from AIMS/Other institutions   Illustrative cases
12.45-1.30 PM Blood Product Management during and after cardiac surgery Talks Standard of care  for blood product usage and it’s rationale 15+ 5 min Ravi Thiagarajan Brijesh PK Vijay Raju,  Raja Joshi,  Thomas Koshy, Sandy Staveski  
Personal experience from a low resource environment 10 min Benedict Raj  
1.30-2.15 PM Lunch
2.15-3.20 PM Managing long ICU stays Talks and cases PCICU staff physician Perspective 15 min   Suchitra Ranjith Lara Shekerdemian, Satish, Rayan Shetty, Nand Kishore; Suja (SCTIMST) Lecture
PCICU nurse perspective 15 min Justine Fortkiewicz Lecture
2 Case studies 30 min AIMS/Other institutions  two cases
Summing up -Discussion 10 min Session Moderator  
3.20-3.40 PM Tea Break
3.40 PM Fast tracking in cardiac post operative intensive care: Who get’s it and What is needed Talks and institutional experience The North American Experience 15+5 min Lara Shekerdemian Aveek Jayant  Sandy Staveski, Ravi Thiagarajan, Soo Kok Wai, Vipul Sharma, Prassanna Salvi, Nitya; Lecture
  LMIC Perspective 15+5 min Keshavamurthy  
4.15 PM Data from LMIC institutions (two or three programs to present their strategies) three brief presentations  30 min Three presentations from LMIC centers  Presentation of institutional data
4.45 PM Closing Remarks and Announcement on the Kochi Declaration

Contact Us

Department of Pediatric Cardiology
Amrita Institute of Medical Science and Research Center
Ponnekkara P.O, Cochin, Kerala
pin :- 682041
Fax : 91-484-2802020
Amritapuri campus Clappana P. O.
For any queries, contact:
+91 9447702096 (Rinku)
+91 7994999610 (Neethu)
+91 7994999810 (Vaisakh)

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