Optimizing Patient Access During an Emergency While Using Intraoperative Computed Tomography.

Area of Science:

• Neurosurgery
• Medical Imaging
• Patient Safety

Background:

• Minimally invasive spine surgery increasingly utilizes intraoperative computed tomography (iCT) for enhanced imaging and surgical precision.
• Current iCT systems present patient safety risks due to space constraints, hindering emergency access, especially with prone patients.
• An institutional near-cardiac arrest highlighted difficulties in patient repositioning for resuscitation due to iCT presence.

Purpose of the Study:

• To develop and test an emergency protocol ensuring timely patient care during critical events in the operating room.
• To address the logistical challenges posed by iCT systems in emergency patient management, particularly during prone positioning.

Main Methods:

• A multidisciplinary operating room team planning meeting was convened to create a detailed emergency action plan.
• The plan was refined based on stakeholder feedback and subsequently tested through a simulated cardiac arrest scenario.
• A mannequin in the prone position within the iCT was used to rehearse the resuscitation protocol.

Main Results:

• The simulated resuscitation demonstrated a 110-second turnaround time from cardiac arrest to patient repositioning from prone to supine.
• Post-simulation review utilized recorded data to assess team performance.
• The protocol's application in an actual cardiac arrest correlated with successful restoration of spontaneous circulation and complete patient recovery.

Conclusions:

• Developing and rehearsing an emergency plan significantly improved the neurosurgical team's responsiveness during a simulated cardiac arrest.
• The process effectively identified and resolved logistical issues associated with iCT system use in critical situations.
• The established protocol enhances patient safety and care during emergencies in iCT-equipped operating rooms.