Assessment of three methods for removing massive air in a cardiopulmonary bypass circuit: simulation-based multi-discipline training in West China Hospital

Abstract

Background and Objective: A multi-discipline cardiac and cardiopulmonary bypass (CPB) team simulation scenario was established to compare three different de-airing approaches dealing with massive air embolism in CPB, so as to formulate a standardized procedure to handle this adverse acute event more proficiently and ensure clinical safety. Method: A simulation-based clinical CPB massive air embolism scenario was developed by a cardiac and CPB team. Study Objects: Five licensed perfusionists and five CPB trainees were matched randomly into five pairs. Each pair would simulate the three different de-airing approaches separately as followed: (1) Conventional Method: arterial line filter (ALF) de-airing purge line and oxygenator self-recirculation bypass were used to de-air; (2) Arterial-Venous Loop (A-V Loop) Method: surgeons reconnected the arterial and venous lines to de-air by restoring the original priming A-V loop configuration; (3) Isolation of the ALF Method: this ensures de-bubbling of the CPB circuit, but bypasses the ALF function. Assessment Criteria: (1) Times to recovery (duration of the circulation suspension); (2) Subjective evaluation of skill and non-skill performances. Results: As to times to recovery, the Conventional Method group took 290.6 s ± 36.2, the A-V Loop Method group took 196.8 s ± 52.0 and the Isolation of ALF group took 99.4 s ± 15.1. The statistical difference is significant among the three groups (p<0.01). The subjective evaluation of training performance indicates that this simulation-based training is effective in assessing both skill and non-skill abilities. Conclusion: CPB simulation-based training was effective in comparing de-airing strategies and can instruct perfusion practices how to optimize techniques. For well-trained, multi-discipline cardiac teams, the A-V Loop Method is highly efficient and reliable in managing CPB massive air embolism. For cardiac teams that do not have this sophisticated training, the Isolation of ALF Method should be their alternative option.

What Do We Know About Teamwork in Chinese Hospitals? A Systematic Review

“…Two studies find the inputs (e.g., surgical skills and emergency skills) significantly improved after the training (57,58), while two other studies observe significantly better outcomes (e.g., task complete compliance and work efficiency) in the simulation group, compared to the non-simulation group (56) or preintervention group (54). One study concludes that licensed perfusionists score communication and coordination higher than the trainees in a cardiac surgery simulation scenario, without testing significance (55). In addition to the studies on simulationbased training, there is one study on TeamSTEPPS (i.e., Team Strategies and Tools to Enhance Performance and Patient Safety).…”

“…Simulation, the core of simulation-based training, refers to "a technique to replace or amplify real-patient experiences with guided experiences, artificially contrived, that evokes or replicates substantial aspects of the real world in a fully interactive manner" (53). All the five studies on simulationbased training are conducted in emergency settings (e.g., trauma care, pediatric septic shock, cardiac surgeries, and advanced cardiac life support) (54)(55)(56)(57)(58). The forms of simulated scenarios include mannequins (55), simulators (56), and animals (58).…”

“…All the five studies on simulationbased training are conducted in emergency settings (e.g., trauma care, pediatric septic shock, cardiac surgeries, and advanced cardiac life support) (54)(55)(56)(57)(58). The forms of simulated scenarios include mannequins (55), simulators (56), and animals (58). Two studies find the inputs (e.g., surgical skills and emergency skills) significantly improved after the training (57,58), while two other studies observe significantly better outcomes (e.g., task complete compliance and work efficiency) in the simulation group, compared to the non-simulation group (56) or preintervention group (54).…”