Abstract P159: The Cardiac Surgery Advanced Life Support Course: Delivering Significant Improvements in Emergency Cardiothoracic Care
Introduction and aims: The European guidelines for resuscitation after cardiac surgery are based on successful resuscitation after cardiac surgery differing from generic resuscitation guidelines in arrhythmia, drug and surgical management. It is a multi-practitioner activity with 6 key identified roles that need allocated and rehearsed regularly. We have created 3-day cardiac surgery advanced life support course to teach the optimal management of a cardiac arrest and emergency resternotomy. We sought to determine the effect of this course on the management of simulated critically ill and cardiac arrest patients.
Materials and methods: Twenty-four candidates participated in the course. Critically ill patients were simulated using intubated mannikins, with lines and drains in situ, and a laptop with an intensive care unit monitor simulation program. Candidates were tested before and after the course with rigidly predesigned clinical situations. Candidates were split into groups of 6, and cardiac arrests were simulated in the same fashion, with all required surgical equipment immediately available. All scenarios were videotaped, and after blinding, an independent surgeon assessed the times to achieve predetermined clinical endpoints.
Results: The time to successful definitive treatment was significantly faster postcourse for the critically ill patient scenarios: (565 secs [SD 27 secs] precourse, compared with 303 secs [SD 24 secs] postcourse; p<0.0005). In addition, the times taken to achieve a wide range of predetermined objectives, including airway check, assessing breathing, circulation assessment, treating with oxygen, appropriate treatment of the circulation, and requesting blood gases, chest radiographs, and electrocardiograms, were also significantly faster in the postcourse scenarios. Times to successful chest re-opening and internal cardiac massage were also significantly improved in cardiac arrest patients: (451 secs [SD 39 secs] precourse and 228 secs [SD 17 secs] postcourse; p=0.011)
Conclusion: We have demonstrated that practising European guideline derived protocol-based arrest management halves the time to chest reopening and reduces complications in the conduct of the resternotomy after cardiac surgery.