There are many daunting challenges that need to be met by any seeking to achieve leadership in the area of cardiac intensive care. Paediatric cardiac intensive care has now emerged as a specialized clinical area, focusing on the unique needs of critically-ill neonates, children, and adults with congenital and acquired heart disease.1 Although an increasing number of centres dealing with paediatric cardiology have either started, or are considering starting, a dedicated cardiac intensive care unit and programme, there are no published primers regarding the logistical aspects of such a challenging endeavour. While there may be an ongoing debate about the preferred strategy in the clinical ownership of the patients treated in intensive care, most authorities agree that it is beneficial to have a dedicated team devoted to the needs of critically-ill children and adults with congenital and acquired cardiac disease.