Interprofessional veno-veno bypass simulation improved team confidence

BACKGROUND

Rarely performed procedures can cause stress and communication challenges in emergency situations. A simulation was developed to practice and improve team performance and procedural workflow when it has been determined that a liver transplant patient will need veno-veno bypass. The scenario involved a patient predetermined to need veno-veno bypass to allow team members to practice procedural workflow and communication. The simulation used a checklist outlining steps of the procedure and expected communication needed among surgeon, anesthesiologist, nurses, and perfusion team members. Perfusion and nursing supplied equipment to simulate the veno-veno bypass. Debriefing and a brief survey followed the simulation.

RESULTS

During the simulation participants performed steps outlined in the checklist. During debriefing, discussion occurred regarding equipment usage, step order, time documentation, and medication use. Additional discussions occurred regarding modifying perfusion tubing and supplies. Participants rated their confidence in understanding communication (4.2), ability to work with others (4.6), knowledge of supplies (4.4), and use of closed-loop communication (4.4) on a scale of 1 (not at all confident) to 5 (extremely confident) (n = 5).

CONCLUSION

Participants concluded going through veno-veno bypass steps was a positive experience. Surgeons acknowledged there were multiple ways to perform this procedure and agreed it should be done the same way each time for standardization. Nursing staff commented they liked reviewing equipment in a nonemergency situation. The checklist will be turned into a resource for future operating room procedures. The perfusion team made modifications to their equipment based on surgeon recommendations. Future training is planned when new members join the team.

Fundamental clinical skills of adult cardiopulmonary bypass: results of the 2017 national survey

INTRODUCTION

Training students to become entry-level perfusionists requires evaluation and assessment of their clinical skills. While our professional organizations have compiled resources which identify the profession's knowledge base and categorical skills applied to clinical practice, these resources are lacking the necessary detail to develop validated clinical assessment rubrics. Therefore, the purpose of this project is to identify, through expert opinion, the detailed fundamental skills necessary to perform adult cardiopulmonary bypass (CPB).

METHODS

We define a fundamental skill based upon frequency of use and risk of harm. A skill that experts report is conducted in >50% of their CPB cases - and, if not properly conducted, can cause harm, is deemed a fundamental skill. To identify these skills, a 73-question survey was developed and posted on PerfList and PerfMail from May 2017 to July 2017.

RESULTS

The results from 261 respondents were analyzed. The demographics of the participants were representative of the workforce. Twenty skills were surveyed and all 20 met the criteria to be identified as a fundamental skill. Data regarding the actions, assessments and behaviors that may be associated with fundamental skills were also identified.

CONCLUSIONS

Based upon this survey data, we have identified that there is consensus within our profession regarding the fundamental skills of adult CPB and a core body of actions, assessments and behaviors that experts perform when conducting these skills. This information may be incorporated into the entry-level educational process to inform curricula and design valid assessment rubrics.

Developing a Quality Standard for Verbal Communication During CABG Procedures

Verbal communication during coronary artery bypass graft (CABG) procedures is essential for safe and efficient cardiac surgery, yet sensitive to failure due to a current lack of standardization. The goal of this study was to improve communication during CABG by identifying critical items in verbal interaction between surgeons, anesthetists, and perfusionists. Based on 6 video recordings, a list was assembled containing items of communication in CABG procedures. Personal interviews and a consecutive focus group meeting with surgeons, anesthetists, and perfusionists revealed which of these items were considered critical. Afterward, the recordings were systematically analyzed on the communication of these critical items. Practitioners considered 64 items to be critical to verbally communicate for safe CABG surgery. On average, these critical items were verbalized in 4.4 out of 6 recorded CABGs. Observations also show that the surgical subteam is the most verbally active subteam and the initiator of the majority of all exchanges. The exchange type involved was mainly "direction" and "status." The majority of communication during critical events is between 2 subteams and occurs in the form of call-back loops. Over half of the call-backs are substantive and communication is rarely directed at a specific team member by name. In this study, a list was developed containing 64 items that practitioners unanimously considered critical to verbalize during a CABG procedure. It forms the foundation of a quality standard for verbal communication during cardiopulmonary bypass (CPB) and can increase safety and efficiency of cardiac surgery.

Assessment of three methods for removing massive air in a cardiopulmonary bypass circuit: simulation-based multi-discipline training in West China Hospital

BACKGROUND AND OBJECTIVE

A multi-discipline cardiac and cardiopulmonary bypass (CPB) team simulation scenario was established to compare three different de-airing approaches dealing with massive air embolism in CPB, so as to formulate a standardized procedure to handle this adverse acute event more proficiently and ensure clinical safety.

METHOD

A simulation-based clinical CPB massive air embolism scenario was developed by a cardiac and CPB team. Study Objects: Five licensed perfusionists and five CPB trainees were matched randomly into five pairs. Each pair would simulate the three different de-airing approaches separately as followed: (1) Conventional Method: arterial line filter (ALF) de-airing purge line and oxygenator self-recirculation bypass were used to de-air; (2) Arterial-Venous Loop (A-V Loop) Method: surgeons reconnected the arterial and venous lines to de-air by restoring the original priming A-V loop configuration; (3) Isolation of the ALF Method: this ensures de-bubbling of the CPB circuit, but bypasses the ALF function. Assessment Criteria: (1) Times to recovery (duration of the circulation suspension); (2) Subjective evaluation of skill and non-skill performances.

RESULTS

As to times to recovery, the Conventional Method group took 290.6 s ± 36.2, the A-V Loop Method group took 196.8 s ± 52.0 and the Isolation of ALF group took 99.4 s ± 15.1. The statistical difference is significant among the three groups (p<0.01). The subjective evaluation of training performance indicates that this simulation-based training is effective in assessing both skill and non-skill abilities.

CONCLUSION

CPB simulation-based training was effective in comparing de-airing strategies and can instruct perfusion practices how to optimize techniques. For well-trained, multi-discipline cardiac teams, the A-V Loop Method is highly efficient and reliable in managing CPB massive air embolism. For cardiac teams that do not have this sophisticated training, the Isolation of ALF Method should be their alternative option.

Assessment of team training in management of adverse acute events occurring during cardiopulmonary bypass procedure: a pilot study based on an animal simulation model (Fouilloux, Team training in cardiac surgery)

BACKGROUND

Successful cardiac surgery is highly dependent upon effective and efficient teamwork. Practical training and development will further enhance the team ability to react to a series of low-frequency occurring adverse events during cardiopulmonary bypass (CPB). One of our specialized educational programs focuses on training the whole team. This training is based on an original animal simulation model. The objective of this pilot study was to assess our method of training and learning in an attempt to optimize and improve team management and functioning.

METHODS

Four members of the same cardiac surgery team joined our program. They performed a common procedure, with a cardiopulmonary bypass (CPB) circuit set up to produce several adverse incidents. Events management was analyzed and debriefed in technical and non-technical perspectives.

RESULTS

Management of the adverse events was significantly improved. Discussion and debriefing time was fundamental in identifying the most appropriate management for each event. Rescue procedures were assimilated and team training was found to be effective, with the time reduced by up to 50% for 3 events and by up to 70% for air embolism.

CONCLUSION

Our pilot program is an innovative, low-cost tool for the improvement of the management of adverse events occurring during CPB. It includes the different components of surgical education and training. Such an educational tool might be relevant for training. To confirm those encouraging results, it should be assessed in a larger surgical team panel. Further investigations are required for assessing efficiency in real conditions.