Additional specialist training for cardiac intensive care staff on cardiac arrests is urgently needed

Abstract

order to obtain median values and percentiles for each postoperative day. ResultsData (median and percentile) are shown in Fig. 1. Median CRP reached peak values in the second and third postoperative days (179 and 194 mg.dl )1 respectively). DiscussionValues of CRP increase following uncomplicated valve surgery with peak values on days 2-3 postoperatively. Further analysis is required to ascertain whether this early CRP profile differs from that in patients who develop postoperative complications. . We do not however have a clear idea of the current level of skills possessed by cardiac ICU nurses in our region and we therefore conducted a three-centre survey to elucidate this more clearly. MethodsA survey was conducted in three cardiac ICUs. Two shifts at each centre were selected to ensure high compliance.The survey asked the respondent to rank their confidence in a range of clinical skills required in either a medical or in a cardiothoracic cardiac arrest. ResultsSixty-one nursing staff were questioned: 48 staff nurses, 12 sisters and one matron. Mean (range) number of years in the cardiac ICU was 5.5 (1-20) years, and number of chest re-openings that they had attended was 9 (0-50+). Of the nurses, 79% were happy to perform external defibrillation, 81% did not know how to perform internal defibrillation, and 40% did not know how to connect up the internal defibrillators. Thirty-nine percent of nurses would not be confident to drape the patient while maintaining good sterility and only 30% had ever put on a sterile gown and gloves to assist at a chest reopening. Sixty-nine percent would not feel confident to pass the correct instruments to a surgeon from a thoracotomy set and 71% did not know how to set-up an intra-aortic balloon pump machine. Ninety-two percent would not be confident to re-open the sternotomy incision even if clinically required, 86% would not know how to remove the sternal wires, and 84% of staff members would not be able to perform internal cardiac massage. While 85% had received Basic or Advanced Cardiac Life Support training, only four nurses had ever received any formal training for cardiac arrests in patients following cardiac surgery; 96% of nurse would go on such a course if available. DiscussionOur survey has identified critical gaps in the skill base of our cardiothoracic nursing staff. We advocate programmes of formal training in all UK cardiothoracic ICUs to address this deficiency.