The Ten-Minute Interview with... Bryan K. Foucha BS, RRT, RCIS

I have lived and worked in the New Orleans area my entire life. I am truly blessed to be part of a wonderful family. My loving wife Charlotte is always there to give me support when it is needed. We are blessed with two great children: Alec (age 12) and Kyle (age 9). As a family, we love to do outdoor activities such as camping and traveling whenever possible. You have to have a special family to endure the on-call cath lab requirements. I am a 1996 graduate of Louisiana State University Medical Center (LSUMC) with a bachelor’s degree in cardiopulmonary science. I received my registry as a respiratory therapist in 1996 and my registry in invasive cardiology (the registered cardiovascular invasive specialist, or RCIS) in 1998. For the past 13 years, I have worked in the cardiac catheterization lab at LSU Health Science Center. Why did you choose to work in the invasive cardiology field? As long as I can remember, cardiology has always interested me. During my college years at LSUMC, my interest in cardiology was confirmed. The more I learned about cardiac anatomy, physiology, and hemodynamics, the further I wanted to pursue it as a career. I chose every elective possible related to cardiac catheterization lab and got to know the staff quite well. I was offered a position in the cardiac cath lab right after graduation. Can you describe your role in the cardiovascular lab? My primary role in the cath lab is to monitor and record hemodynamics. Another role that I have taken on is to help with the education of new employees, fellows, and the many students passing through our labs. We are a teaching hospital affiliated with two major medical schools: LSU Medical School and Tulane University Medical School. Each school has a full complement of fellows to scrub on procedures. Unless there is an occasional difficult intervention or device implant in the electrophysiology (EP) lab, I don’t get a chance to scrub in often. What is the biggest challenge you see regarding your educational role? The biggest challenge I face is the lack of knowledge about the utilization of respiratory therapists within the cath lab setting. The fact is that registered respiratory therapists (RRTs) have been working in the cath lab setting for many years, all across the country. Speaking as a respiratory therapist with cardio-pulmonary knowledge, I believe we are a perfect fit to move directly into the role of a Registered Cardiovascular Invasive Specialists (RCIS). Registered nurses (RNs), RRTs and other allied health professions such as registered radiologic technologists [RT(R)s] and emergency medical technicians – paramedics (EMT-Ps) with at least an associates degree are eligible to sit for the RCIS exam given by Cardiovascular Credentialing International (CCI). This could become a major factor in the near future with regards to staffing issues and Medicare reimbursement, due to the Consistency, Accuracy, Responsibility and Excellence (CARE) in Medical Imaging and Radiation Therapy Bill being re-introduced this fall to the 111th United States Congress. What motivates you to continue your involvement with the cath lab? Within the cath lab, the newest technology and advanced techniques are always just around the corner. You are continuously being challenged to learn and utilize the latest in medical supplies and equipment. Additionally, I like to teach coronary anatomy and hemodynamics. It is always rewarding to see the expressions on the students’ faces the first time they see the coronary arteries light up with contrast. Have you ever been involved in a particularly unusual case? The following is not really an unusual case; however, it is a case that I have shared with many students over the years. I was called in for an acute myocardial infarction (MI), and with quick response, got the elderly female patient to our cath lab to begin the case. The EKG directed us to proceed to an urgent intervention of the right coronary artery (RCA). After our first picture, the EKG was confirmed. The patient had a mid-RCA thrombus totally occluding her huge vessel. During the procedure, she went into ventricular tachycardia (v-tach) several times. I ultimately spent the remainder of the procedure delivering multiple defibrillations between balloon inflations. She kept grabbing my wrist and begging me not to shock her again. I had to wait for her to pass out and release my wrist before I could deliver the next defibrillation. The intervention of the RCA was a success. We then proceeded to the left coronary systems. We took one picture of the left coronary arteries and she went into v-tach once again. After one more successful defibrillation, we immediately ended the case and sent the patient to intensive care unit (ICU). During the last picture of the left coronary system, we actually captured the fibrillation on cine. We continue to incorporate that film often for educational purposes. When work gets stressful and you experience low moments (as we all do), what do you do to help keep your morale high? I have always believed in keeping the mood light. Our patients and their family members are rightfully very nervous and quite upset. I try to break the tension with humor whenever possible. Laughter is the best medicine sometimes. Are you involved with the SICP or any other cardiovascular societies? I have been a member of the Society of Invasive Cardiovascular Professionals (SICP) since 2005. Over the past year, I have become more active within the organization. Recently, I published an article in Cath Lab Digest entitled, “The ABC’s of A to V: Right Atrial/Left Atrial (PCW) Pressures” (May 2009, vol. 17, no. 5). I have been working with the SICP advocacy committee with regards to education and RCIS recognition issues. I have also been a member of the American Association for Respiratory Care (AARC) since 1995. Are there websites or texts that you would recommend to other cardiovascular labs? I think that everyone working in the field of invasive cardiology should have access to Cardiac Catheterization, Angiography and Intervention by Grossman/Baim (published by Lippincott Williams & Wilkins), The Cardiac Catheterization Handbook by Morton Kern, MD (published by Saunders), and one of the newest books available, Cardiology: Handbook for Clinicians by Elias Hanna, MD (published by Scrub Hill Press). As for informative websites, I would recommend CathLabDigest.com, CathLab.com, SICP.com, CCI-online.org, JRCCVT.org, SCAI.org, ASRT.org, AARC.org, NBRC.org, ISMIPSI.com, and Blaufuss.org (electrophysiology tutorials). Do you remember participating in your first invasive procedure? My first invasive procedure seen as a student was a percutaneous transluminal coronary angioplasty (PTCA) 13 years ago. Everyone in the room had a certain duty to perform. Everyone anticipated the next step and worked well as a team. I was impressed with the knowledge from the cath lab staff about the equipment and supplies utilized. I thought that this environment would be an extremely interesting place to work. If you could send a message back to yourself at the beginning of your cardiovascular career, what advice would you give? My first message that I would send back to myself is to take full advantage of every learning opportunity offered. One never knows when that lesson given by a sales representative is needed at 2:00 am, when there is minimal staff to rely upon. I would also tell myself to get involved with many professional organizations as soon as possible. I regret that I waited so long to get involved. Where do you hope to be in your career when it is time to retire? As far as my personal aspirations, I would like to advance my RCIS credentialing level. I am following closely the exceptional work of the International Society of Advanced Level Medical Imaging Physician Specialist Incorporated (ISMIPSI). The ISMIPSI is developing credentialing avenues for an Advanced Level Cardiology Specialist Assistant. [Ed: See the “Letter to the Editor” in this month’s issue for links to this information.) When it is time to retire, I hope to look back and see many careers that I have influenced in a positive way. I would like to know that I have made contributions to the advancement in the field of invasive cardiology. Has anyone in particular been helpful to you in your growth as a cardiovascular professional? If I had to choose one person that has been helpful to my growth as a cardiovascular professional, it would have to be Dr. John Zamjahn, PhD, RRT, RCVT, Assistant Professor of Cardiopulmonary Science at LSU Medical Center. Dr. Zamjahn was my instructor for my invasive cardiology classes at LSUMC. He was influential in teaching all aspects of the cardiac cath lab, including techniques, hemodynamics, and cardiac physiology. I still refer to the notes from his class. Dr. Zamjahn’s notes and guidance were my primary source of reference when I studied and passed the RCIS exam. There have also been many staff members here at LSU Health Science Center, from RNs to RTs, to CVTs and physicians that have made an immeasurable impact on my career thus far. Where do you think the invasive cardiovascular field is headed in the future? With advancements in equipment and the increasing use of percutaneous approaches to achieve atrial septal defect (ASD) closures, valvuloplasties, and mitral valve repairs, there will be a significant decrease in the necessity of open chest surgical procedures. As far as staffing is concerned, organizations such as the SICP have many people working toward educating hospital administration on the importance of education and credentialing within the cath lab. Nationally, more and more labs are implementing new staffing standards even before the passage of the pending congressional legislation. There will be a steady increase in the need for the RCIS credential. If the CARE Bill passes through Congress, the need for RCIS-credentialed cath lab staff members will be tremendously increased. This increased demand will result in the establishment of additional CVT programs around the country. Bryan K Foucha can be reached at bfouch@lsuhsc.edu

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