A cardiac arrest following heart surgery is a rare event, but when it happens, good communication and cooperation are key. A team of Weill Cornell Medicine physicians, nurses and fellows had the opportunity to practice their response to such an event in the Skills Acquisition & Innovation Laboratory (SAIL) on February 11.
Administered jointly by the Departments of Anesthesiology, Surgery and Radiology at Weill Cornell Medicine and NewYork-Presbyterian, SAIL is a teaching and research laboratory that utilizes simulation technology to train healthcare professionals.
The simulation opened with participants monitoring a patient following mitral valve repair and coronary artery bypass grafting in a simulated cardiothoracic intensive care unit (CTICU). The patient was represented by SAIL’s state-of-the-art, lifelike manikin.
“We began with a patient a few hours after arriving to the ICU that had a drop in her blood pressure. After a few minutes she had a cardiac arrest due to ventricular fibrillation," said Dr. Natalia Ivascu, associate professor of clinical anesthesiology and the medical director of the CTICU. Unable to resuscitate the patient, participants proceeded to open her chest using an artificial sternum that was obtained by SAIL.
“It sounds easy to re-open the chest because the patient just had surgery, but the breast bone is wired shut so the surgeons have to actually cut and pull the wires out,” said Dr. Ivascu. “Basically we need to transform the ICU room into an operating room in a matter of seconds."
It’s a unique circumstance, Dr. Ivascu added, and one that few participants would have the opportunity to master outside of the lab.
Drs. Natalia Ivascu and Lori Rubin run the simulation from the SAIL control room.
Dr. Meghann Fitzgerald, assistant professor of anesthesiology, developed the workshop and led the debriefing sessions. The simulation was also led by Dr. Lori Rubin, associate professor of clinical anesthesiology and the co-director of SAIL.
A key part of the simulation was the discussion periods. SAIL’s high-definition recording capabilities allowed the teams to review and discuss the scenario, practice important communication strategies and apply what they learned to a second case.
“We hope to repeat this process regularly to become experts in carrying out the steps of a low-frequency event and to introduce new team members to the process," said Dr. Fitzgerald.