Simulation Education in Anesthesia Training: A Case Report of Successful Resuscitation of Bupivacaine-Induced Cardiac Arrest Linked to Recent Simulation Training

Abstract

Simulation training is rapidly becoming an integral element of the education curriculum of anesthesia residency programs. We report a case of successful resuscitation of bupivacaine-induced cardiac arrest treated with i.v. lipid emulsion by providers who had recently participated in simulation training involving a scenario nearly identical to this case. Upon debriefing, it was determined that the previous training influenced execution of the following steps: rapid problem recognition, prompt initiation of specific therapy in the setting of supportive advanced cardiac life support measures, and coordinated team efforts. Although the true cause of efficient resuscitation and ultimate recovery cannot be proven, the efficiency of the resuscitation process, including timely administration of lipid emulsion, is evidence that simulation may be useful for training providers to manage rare emergencies.

Part 8: Advanced Life Support

“…[492][493][494][495][496] Five single-case reports (LOE 5) describe patients with acute, life-threatening cardiovascular toxicity from local anesthetic intoxication, but who were not pulseless at the time of lipid administration. In 3 cases [497][498][499] severe cardiovascular toxicity resolved rapidly following IV lipid, but in 2 other cases 500,501 the patient's condition deteriorated to cardiac arrest after IV lipid, although the patients were resuscitated and survived to hospital discharge.…”

Lipid Emulsion Infusion in Resuscitation for Local Anesthetic and Other Drug Overdose

“…The treating physician was aware of the previous case and therefore ordered the infusion of lipid emulsion after 15 min of failed standard resuscitation. Similarly, Smith et al [25] reported an apparent save of a patient in cardiac arrest following a bupivacaine-based peripheral nerve block when physicians who had recently attended a simulator course that included a lipid scenario administered the emulsion. These cases emphasize the positive effect that education and awareness of the method can have on patient outcome.…”

“…Two recent publications have summarized individual cases reported in the literature [25,26]. Case report data can be instructional in offering insights into therapies, and are particularly useful when outlining an "all or nothing" type clinical situation.…”

Lipid rescue: the use of lipid emulsions to treat local anaesthetic toxicity

“…Because of the rarity and severity of local anaesthetic-induced cardiotoxicity, it is not possible or ethical to conduct human research on the underlying problem. 36 Human case reports 11,19,20,[37][38][39][40][41][42][43][44][45] describing successful lipid rescue are therefore invaluable. 26 When should lipid therapy be started?…”

“…46 As confidence with this therapeutic modality grows, case reports indicate progressively earlier administration of lipid emulsion during resuscitation. [19][20][21][22]37,38 This has led Weinberg to retract his earlier conservative recommendation "that lipid infusion be delayed until standard resuscitative measures failed". 10,23,46,47 What are the implications of earlier institution of lipid therapy in the presence of local anaesthetic toxicity?…”