The Practice of Pediatric Cardiac Anesthesiology in the United States

Abstract

BACKGROUND: With advances in surgical and catheter-based interventions and technologies in patients with congenital heart disease (CHD), the practice of pediatric cardiac anesthesiology has evolved in parallel with pediatric cardiac surgery and pediatric cardiology as a distinct subspecialty over the past 80 years. To date, there has not been an analysis of the distribution of pediatric cardiac anesthesiologists relative to cardiac and noncardiac procedures in the pediatric population. The primary aim is to report the results of a survey and its subsequent analysis to describe the distribution of pediatric cardiac anesthesiologists relative to pediatric cardiac procedures that include surgical interventions, cardiac catheterization procedures, imaging studies (echocardiography, magnetic resonance, computed tomography, positron emission tomography), and noncardiac procedures. METHODS: A survey developed in Research Electronic Data Capture (REDcap) was sent to the identifiable division chiefs/cardiac directors of 113 pediatric cardiac anesthesia programs in the United States. Data regarding cardiac surgical patients and procedures were collected from the Society of Thoracic Surgeons Congenital Heart Surgery Database (STS-CHD). RESULTS: This analysis reveals that only 38% (117 of 307) of pediatric cardiac anesthesiologists caring for patients with CHD pursued additional training in pediatric cardiac anesthesiology, while 44% (136 of 307) have gained experience during their clinical practice. Other providers have pursued different training pathways such as adult cardiac anesthesiology or pediatric critical care. Based on this survey, pediatric cardiac anesthesiologists devote 35% (interquartile range [IQR], 20%–50%) of clinical time to the care of patients in the cardiac operating room, 25% (20%–35%) of time to the care of patients in the cardiac catheterization laboratory, 10% (5%–10%) to patient care in imaging locations, and 15% covering general pediatric, adult, or cardiac patients undergoing noncardiac procedures. Attempts to actively recruit pediatric cardiac anesthesiologists were reported by 49.2% (29 of 59) of the institutions surveyed. Impending retirement of staff was anticipated in 17% (10 of 59) of the institutions, while loss of staff to relocation was anticipated in 3.4% (2 of 59) of institutions. Thirty-seven percent of institutions reported that they anticipated no immediate changes in current staffing levels. CONCLUSIONS: The majority of currently practicing pediatric cardiac anesthesiologists have not completed a fellowship training in the subspecialty. There is, and will continue to be, a need for subspecialty training to meet increasing demand for services especially with increase survival of this patient population and to replace retiring members of the workforce.

The Year in Review: Anesthesia for Congenital Heart Disease 2022

“…However, currently, in a survey from Nasr et al sent to 113 pediatric cardiac anesthesia programs, only 38% (117 of 307) of pediatric cardiac anesthesiologists pursued subspecialty training, while the majority gained "on the job" training or alternative training routes. 22 With greater recognition for additional training required to gain the skillset necessary to care for the CHD population, there has been a call to standardize this education. The previous model had been for programs offering an additional year of training in pediatric cardiac anesthesiology to offer their own curriculum of varying lengths and often structured as a faculty-fellow position.…”

“…In that same U.S. survey, 49.2% of institutions were actively recruiting staff. 22 The additional effects of the COVID-19 pandemic on the total number of practicing pediatric anesthesiologists may also increase demand. In a poll sent to all 3245 members of the Society for Pediatric Anesthesiology (SPA) with 561 respondents, Margolis et al found that 10.6% of respondents would reduce their professional working time, and 14.2% planned on retiring earlier while 11.9% planned to retire later.…”

“…However, currently, in a survey from Nasr et al sent to 113 pediatric cardiac anesthesia programs, only 38% (117 of 307) of pediatric cardiac anesthesiologists pursued subspecialty training, while the majority gained “on the job” training or alternative training routes. 22…”

Adverse Events in the Pediatric Cardiac Catheterization Suite: Does Having Pediatric Cardiac Anesthesiologists Make a Difference?

“…4 However, current staffing shortages and staffing paradigms do not always allow for a pediatric cardiac anesthesiologist to be present in the catheterization lab at all times. 6 Until very recently, the field of pediatric cardiac anesthesiology had no formal Accreditation Council for Graduate Medical Education training requirements. Most tertiary care centers have teams of pediatric cardiac anesthesiologists who have acquired training through a multitude of different pathways.…”

Closing the Knowledge Translation Gap: Health Services Research and Perioperative Medicine—New Horizons for Anesthesiologists

“…The process of how we deliver perioperative care is discussed by 2 papers that examine preanesthesia consultation and the provision of care to young children undergoing cardiac surgery. 4,5 Examining current routine care is also the role of HSR. While much has been published on the need to restrict the use of benzodiazepines because of concerns for delirium and delayed postoperative neurocognitive recovery, Cozowicz et al 6 found that 4 of 5 patients undergoing major orthopedic surgery in the United States receive benzodiazepines perioperatively, and a small but clinically significant proportion of these patients receive long-acting benzodiazepines.…”