In September 2023, anesthesiologist Nguyen Thi Thu Hang, MD, and perfusionist Nam Do Van, MD traveled from Vietnam National Children’s Hospital (VNCH) in Hanoi to spend six weeks observing the pediatric cardiac care team and learning from UCSF anesthesiologist Hung Nguyen, MD. VNCH partnered with Children’s HeartLink, which has connected hospitals in developing countries with those in the United States, the United Kingdom, and Canada (along with UCSF, Boston Children’s Hospital serves as a volunteer training partner for the organization).
Children’s HeartLink’s mission is to save children’s lives by transforming pediatric heart care in underserved parts of the world. Founded in 1969, Children’s HeartLink has reached more than 2 million children with heart disease and has 22 partner hospitals in 6 countries. Children’s HeartLink relies on donors to help reach its goals, and since 2017, the Ping and Amy Chao Family Foundation has been sponsoring Children’s HeartLink’s work in Hanoi. In Vietnam, an estimated 10,000 children are born with congenital heart disease every year, of which 25% require surgery in the first year of life. Medical volunteers traveled to Vietnam National Children’s Hospital in Hanoi several times to train 170 pediatric cardiac medical professionals. In 2017, the UCSF team was led by Dr. Shunji Sano, a pediatric heart surgeon world-renowned for surgical innovations. At the start of the COVID-19 pandemic, the UCSF team pivoted to virtual training sessions and weekly conference calls to go over complex cases. The doctors discussed treatment planning and case troubleshooting, ensuring each patient had a strong and informed treatment plan.
In 2023, the partnership between Children’s HeartLink and The Chao Foundation allowed Hang and Nam to come to UCSF and study with our world-renowned anesthesia and cardiac team. Hang underscored how “truly meaningful” the sponsorship by Children’s HeartLink is, adding “We hope that in the near future, some more doctors will be able to visit and study directly at UCSF.” For Hang, a cardiac anesthesiologist at VNCH, observing the entire process of patient preparation, anesthesia during surgery, and the transfer of the patient to the intensive care unit after congenital heart surgery was an essential element of her trip. While at UCSF, Hang recorded all the differences in practice between the two hospitals and is planning to change VNCH’s current receiving procedures and equipment to improve surgical results. Nam, a perfusionist from VNCH, shared that his trip primarily focused on learning about advanced perfusion in congenital heart surgery. He also had a chance to observe anesthesia in surgery, cardiovascular intervention for congenital heart patients, and witnessed heart transplantation and VAD placement in infant patients for the first time.
Hang has already put some changes in place. Although VNCH does not have dexmedetomidine and other equipment needed to anesthetize and sedate patients in the cath lab, Hang shared that immediately upon her return to VNCH, her team members implemented what they could, including using ultrasound for endovascular access for all the cases “in the same way that UCSF Professor Hung Nguyen did when anesthetizing cardiac surgeries at UCSF.” Hang reports that based on what she observed during her time at UCSF, she and her team have created a new handover form between the cardiac intensive care unit (CICU) and the OR and have begun using it for all cardiac patients. They also created a new, safer way of transferring the patient by using a full indicator monitor, rather than only two indicators (pulse rate and SpO2).
Both Hang and Nam detailed additional changes they want to make at VNCH, including improving the effectiveness of patient monitoring during CPB (for example, installing NIRS for monitoring cerebral perfusion for patients with CPB and doing venous blood gas every 30 minutes to assess tissue perfusion via SvO2). Nam said he also wants to “apply Echo for assessing artery catheter for every patient, perform extubation in OR for several surgeries such as Glenn and Conduit change, and plan to do Fontan surgery off-pump in the near future.” Nam echoes Hang’s observations, adding that what impressed him most was UCSF’s high standards and efficient systems, “from initial examination, treatment monitoring, surgery planning consultation, every step during surgery (Surgery, Anesthesia, Perfusion, nurses); transfer, handover, and taking care of patients at ICU.” But it was not just the precise clinical work and procedures that impressed Hang and Van, it was the “kind and enthusiastic” way UCSF’s doctors interacted with them–and with each other. Hang said of the cardiac team: “During their work, they always explained and answered our questions about the cases or the situations that develop in each operation, thereby helping us better understand how to practice anesthesia.”
Hang also emphasized the impact her UCSF mentor, Hung Nguyen, has had on her work. Hang underscores how much Nguyen’s “passionate” approach to the field and his practice has taught her, as well as the foundation of patient care, including “how to take care of a patient during surgery and how to monitor and detect common problems.” Nam spent most of his clinical observation time in the company of UCSF’s perfusion team, and notes that “Clinton Jones [of Benioff Children’s Hospital Oakland] is a really good perfusionist; he shared a lot of clinical experience with me.”
Additionally, Hang and Nam spent time in the pediatric CICU and witnessed the care with which the doctors and staff approach our patients. Hang underscored how impressed she was with how well the UCSF’s nurses know their patients from the moment they receive them from the operating room. After seeing the difference this makes for patients and their families, Hang said, “I think that we need to learn how to monitor and evaluate our patients on a daily basis.” Creating and implementing systems based on those he observed at UCSF will improve patient care across VNCH.
Another experience that deepened Nam’s experience was his time in the Cath Lab with Dr. Moore and rounding in the ICU. Nam was “impressed with the way you do interventions for neonatal patients…all steps in the intervention were very careful, precise, and the results were very good. We are also impressed with the way you transport, monitor, and care for patients from the OR, Cath Lab, to the ICU. We will learn these things and apply them appropriately to Vietnam’s conditions, further improving the quality of care for patients undergoing surgery and intervention.”
Nam also indicated how important this trip was professionally: “It helped me witness firsthand that medical care requires the highest and the most rigorous standards. From there, I can compare what we are doing every day at NCH when providing medical care to the same patient population. We found what we can improve quickly and what we can gradually change, in accordance with our conditions. Furthermore, we recognize the urgent need to develop a basic systematic training program on pediatric cardiovascular anesthesia and perfusion in pediatric heart surgery. A difficult job, requiring a lot of resources, time, and help and teaching from your experts.”
Children’s HeartLink partnerships are multi-year. UCSF and VNCH will continue to work together to improve pediatric cardiac care provided at VNCH and grow the hospital into a Children’s HeartLink Center of Excellence. The team at VNCH will grow its expertise in diagnosing and treating more children with complex heart conditions while serving as a regional trainer for other pediatric cardiac clinicians in the country to ensure that all children have access to life-saving care in the country.
