Cardiac resuscitation in the operating room: Reflections on how we can do better

Berry, William R.

doi:10.1007/s12630-012-9697-5

Cited by 14 publications

(6 citation statements)

References 10 publications

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“…Despite an abundance of personnel and equipment in the operating suite, there is a lack of experience in managing these emergency situations [3,5]. To improve robotic crisis management, simulator-training scenarios have been developed [3,6-7].…”

Section: Introductionmentioning

confidence: 99%

Emergency Undocking Curriculum in Robotic Surgery

Ballas¹,

Cesta²,

Gothard³

et al. 2019

Cureus

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Introduction Traditional instruction for robotic surgery is typically devoid of training that addresses the delineation of interprofessional roles for operating room personnel. An emergency undocking scenario was developed for robotic surgeons with the objectives of improving time to access the patient, provider knowledge of and confidence in emergency undocking, completion of predetermined critical actions, and delineation of operating room personnel roles. Methods Over one month, participants joined in three sessions: Session 1 - formative, Session 2 - review, and Session 3 - summative. Embedded standardized participants (ESPs) represented members of the interprofessional team. Prior to entering the operating room for Sessions 1 and 3, trainees were asked to complete a confidence survey and multiple choice questionnaire (MCQ) for knowledge assessment. Participants were randomized to one of two cases and participated in the reciprocal case for the final session four weeks later. Following Session 1, participants underwent an educational intervention, including the proper technique for emergency undocking, emphasis on operating room personnel roles, and hands-on practice. Obstetrics and Gynecology (OBGYN) residents in post-graduate Years 2-4 and attending physicians with robotics privileges at Summa Health Akron Campus or Cleveland Clinic Akron General Medical Center were invited to participate. A total of 21 participants enrolled and finished the study. Results Among the 21 participants, there was a significant increase in the baseline level of knowledge (p-value=0.001) and in the confidence of surgeons when faced with an emergency undocking after the completion of our curriculum (p-value=0.003). Additionally, an improvement in the undocking times (p-value<0.001) and an increase in the critical actions performed (p-value=0.002) were observed. Conclusion The results of this study demonstrate that incorporating this curriculum into the training programs of robotic surgeons is an effective way to improve the surgical skill of emergency undocking.

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Section: Introductionmentioning

confidence: 99%

Emergency Undocking Curriculum in Robotic Surgery

Ballas¹,

Cesta²,

Gothard³

et al. 2019

Cureus

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“…This improved survival may be due to the beneficial effects of ECMO: these include early supply of oxygenated blood to the failing myocardium; short low‐flow time; and provision of time for recovery from potentially reversible conditions of arrest or interventions to correct the causes . Moreover, the favourable environments of intra‐operative resuscitation that allow immediate patient monitoring and the presence of experienced staff with knowledge of patient's condition and resuscitation resources could have contributed to improved survival .…”

Section: Discussionmentioning

confidence: 99%

Extracorporeal cardiopulmonary resuscitation in refractory intra‐operative cardiac arrest: an observational study of 12‐year outcomes in a single tertiary hospital

et al. 2018

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Refractory intra-operative cardiac arrest is a challenging issue for anaesthetists. In this study, we analysed the outcomes of adult patients who received extracorporeal cardiopulmonary resuscitation for refractory intraoperative cardiac arrest between 2005 and 2016, using data from our institutional extracorporeal membrane oxygenation registry. We defined refractory intra-operative cardiac arrest as the failure of a return of spontaneous circulation after 30 min of cardiopulmonary resuscitation. The primary outcome measure was neurologically intact survival with a cerebral performance category score of 1 or 2 at hospital discharge. Between 2005 and 2016, extracorporeal cardiopulmonary resuscitation was used to treat 23 patients who experienced refractory cardiac arrest in the operating room. The survival rates of neurologically-intact subjects were 9/23 (39%) and 6/23 (26%) at 24 h postoperatively and at hospital discharge, respectively. The main cause of refractory-intra-operative cardiac arrest was haemorrhagic shock in 13 out of 23 (57%) patients, and the neurologically-intact survival rate in these patients was 3/13 (23%) at discharge. Our study showed that approximately a quarter of patients with refractory intra-operative cardiac arrest caused by haemorrhage would receive survival benefit from extracorporeal cardiopulmonary resuscitation. Therefore, extracorporeal cardiopulmonary resuscitation may be a possible option in this clinically-challenging situation.

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“…However, it cannot replace clinical experience, good education, regular practice, as well as training in a simulation centre. Five years ago, William Berry stated the following in the editorial commentary of the Canadian Journal of Anesthesia [13], namely: "No patient whose death is avoidable should die in the operating room or hospital -ever" Despite this extremely ambitious statement, a data analysis based on large observational groups, namely recent multi-million cases of patients operated on in Europe and the USA, indicates a worryingly high number of postoperative complications, including death. In the 2012 Pearse study, carried out on a group of approximately 50,000 patients operated on in Europe, an average of 4 patients out of 100 died in the immediate postoperative period with large variations in individual countries [14].…”

Section: Janusz Andresmentioning

confidence: 99%

Rola anestezjologii i intensywnej terapii w zapewnieniu bezpieczeństwa pacjenta w okresie okołooperacyjnym: przeszłość, teraźniejszość i przyszłość

Andres¹

2018

Anaesthesiol Intensive Ther

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Cardiac resuscitation in the operating room: Reflections on how we can do better

Cited by 14 publications

References 10 publications

Emergency Undocking Curriculum in Robotic Surgery

Emergency Undocking Curriculum in Robotic Surgery

Extracorporeal cardiopulmonary resuscitation in refractory intra‐operative cardiac arrest: an observational study of 12‐year outcomes in a single tertiary hospital

Rola anestezjologii i intensywnej terapii w zapewnieniu bezpieczeństwa pacjenta w okresie okołooperacyjnym: przeszłość, teraźniejszość i przyszłość

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