Pediatric Complete Heart Block

Cashen, Katherine; Tilford, Bradley; Sarnaik, Ajit; Clark, Jeff

doi:10.15766/mep_2374-8265.10348

Cited by 1 publication

(1 citation statement)

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“…4,5 The array of critical complications associated with TAVI provided an ideal setting to present symptomatic aortic stenosis, acute cardiac tamponade pathophysiology, and third-degree heart block with symptomatic bradycardia in a low-risk environment while also familiarizing anesthesiology resident learners with the procedure. Within the currently available published simulations, there are scenarios that cover tamponade physiology, anesthesia for aortic stenosis, and symptomatic heart block 6–9 ; however, only one of these is tailored for the intraoperative setting. Our simulation synthesizes much of the core pathophysiology covered in these separate scenarios with a specific focus on intraoperative management and interpretation of advanced invasive monitoring (arterial line, central venous pressure, pulmonary artery catheter), introduces the learner to transesophageal echocardiographic (TEE) diagnosis of cardiac tamponade, and serves as an effective introduction to TAVI.…”

Section: Introductionmentioning

confidence: 99%

Cardiac Tamponade and Complete Heart Block During Transcatheter Aortic Valve Implantation: A Simulation Scenario for Anesthesia Providers

2018

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IntroductionThis simulation on cardiac tamponade and complete heart block in the context of severe aortic stenosis presents the learner with a rare (cardiac tamponade) and a common (complete heart block) complication in the intraoperative setting of transfemoral aortic valve implantation in a high-fidelity, low-risk simulation environment. Based on an amalgam of index cases, the simulation was developed to address a recognized area of need for cardiothoracic anesthesia scenarios in the simulation curriculum of our home institution.MethodsThe simulation case file covered the case narrative, learning objectives, a summary of critical actions performed, and supplemental figures needed to complete the educational activity. A high-fidelity patient simulator, an anesthesia machine, monitors, and a computer capable of displaying standard computer slide presentation software and movie files provided the optimal environment for simulation.ResultsFifteen anesthesia residents experienced the simulation over the 2016–2017 and 2017–2018 academic years. The trainees who experienced this simulation improved their understanding of tamponade hemodynamic pathophysiology and recognition of hemodynamically unstable bradycardia.DiscussionThis case has been an effective addition to the repertoire of simulation scenarios at the University of Iowa and has been incorporated into the general curriculum of simulation cases for mid-training junior and senior anesthesia residents.

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