Cardiac resternotomy after cardiac surgery in kids: CRACK the chest
Jui Shah1, Ashley Sefton1, John Dentel2,3
1Division of Critical Care, Department of Pediatrics, Children's Hospital of Michigan/Central Michigan University, Detroit, MI, USA.
Insights
A new training program improved response times and comfort levels for critical tasks during emergent pediatric cardiac surgery resternotomy. This multidisciplinary intervention enhanced teamwork and technical skills for better patient care.
Area of Science:
- Pediatric Cardiac Surgery
- Critical Care Medicine
- Medical Simulation
Background:
- Emergent resuscitation of pediatric cardiac surgery patients demands specialized skills and teamwork.
- Bedside resternotomy is a critical, albeit rare, life-saving procedure.
- Preparation and performance improvement for resternotomy are underexplored.
Purpose of the Study:
- To evaluate a multidisciplinary educational intervention for emergent pediatric cardiac surgical patients.
- To assess the intervention's impact on decreasing critical task times.
- To measure improvements in caregiver comfort during resternotomy procedures.
Main Methods:
- A simulation-based, in situ resternotomy educational intervention was implemented over three months.
- Weekly educational aids were used during nursing huddles; ICU charge nurses demonstrated competency.
- Post-intervention simulations and surveys were conducted at baseline, immediately after, and at 6 months.
Main Results:
- Significant decreases in time were observed for obtaining defibrillators, setting up resternotomy equipment, and delivering sedation/fluids (p < 0.05).
- Time to escort family and obtain blood also decreased significantly (p < 0.05).
- Provider comfort increased in identifying equipment and setting up internal defibrillator paddles (p < 0.01).
Conclusions:
- A novel educational intervention effectively improved provider comfort during emergent resternotomy.
- The intervention successfully decreased the time to perform critical tasks in this high-stakes scenario.
- This approach enhances preparedness for emergent resternotomy in pediatric cardiac surgery.
Objective:
Emergent resuscitation of postoperative paediatric cardiac surgical patients requires specialised skills and multidisciplinary teamwork. Bedside resternotomy is a rare but life-saving procedure and few studies focus on ways to prepare providers and improve performance. We created a multidisciplinary educational intervention that addressed teamwork and technical skills. We aimed to evaluate the efficiency of the intervention to decrease time to perform critical tasks and improve caregiver comfort.
Methods:
A simulation-based, in situ resternotomy educational intervention was implemented. Pre-intervention data were collected. Educational aids were used weekly during day and night nursing huddles over a three-month period. All ICU charge nurses had separate educational sessions with study personnel and were required to demonstrate competency in all the critical tasks. Post-intervention simulations were performed after intervention and at 6 months and post-intervention surveys were performed.
Results:
A total of 186 providers participated in the intervention. There was a decrease in time to obtain defibrillator, setup resternotomy equipment and internal defibrillator paddles and deliver sedation and fluid (all p < 0.05). Time to escort family from the room and obtain blood was significantly decreased after intervention (p < 0.05). There was no difference in time to first dose of epinephrine, defibrillator pads on the patient, or time to call the cardiovascular surgeon or blood bank. Providers reported increased comfort in identifying equipment needed for resternotomy (p < 0.01) and setting up the internal defibrillator paddles (p < 0.01).
Conclusions:
Implementation of a novel educational intervention increased provider comfort and decreased time to perform critical tasks in an emergent resternotomy scenario.
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