Competency in invasive line monitoring (Swan Ganz, a-lines), pacemakers (epicardial, transvenous), chest tubes, cardiac medications (inotropes, vasopressors, sedation/paralytics), ventilator/trach management, and cardiac rhythm interpretation. Strong department support including 24/7 charge nurse, HUC, dedicated CVICU intensivist, CT surgeon on call, hospitalist, general intensivist, and ICU-designated RT.