A novel approach to combined simulation training in cardiac anesthesia/surgery, in Alberta
The University of Alberta has developed a novel training program using Intelligent Ultrasound’s HeartWorks Transthoracic/Transesophageal Echocardiography (TTE/TEE) system to simulate perioperative cardiac anesthesia/surgical scenarios. Exposure to rare but catastrophic surgical incidents in a controlled, realistic environment allows trainees to take a phased approach to scenario management without the stress of a high-stakes environment.
Located in Edmonton in Alberta, Canada, the University of Alberta is one of the top 5 universities in Canada boasting more than 500 graduate programs. The Mazankowski Alberta Heart Institute, a world leader in complex cardiac care and surgery, is a training site for fellows and residents in both cardiac anesthesia and cardiac surgery. However, prior to the purchase of HeartWorks and the development of a joint cardiac anesthesia/surgery training program, it was difficult to adequately prepare trainees to manage cardiac surgical emergencies. Dr. Surita Sidhu, a cardiac anesthesiologist, was instrumental in the development of the training program, with the University Hospital Foundation’s purchase of the HeartWorks system through a generous donation. A second cardiac anesthesiologist, Dr. Wing Lam, has also been heavily involved in the development of this program.
“As these scenarios are rare but significant, they cannot be recreated in a clinical scenario involving patients. In addition, when they do occur in real life, patient management is of paramount importance and teaching of trainees may not be ideal in life-threatening situations.” Surita Sidhu MD, FRCP(C), FASE, Clinical Professor, Anesthesiology and Pain Medicine.
The HeartWorks TTE/TEE system was initially purchased to allow trainees in cardiac anesthesia/surgical to develop facility with echocardiography skills. Dr. Abigail White, a cardiac surgical trainee, spearheaded the development of a cardiac surgical simulation program at the University of Alberta with support from the program director, Dr. Steven Meyer. Together, Dr. Sidhu and Dr. White have developed a unique training program involving anesthesiologists, surgeons, perfusionists, and cardiac surgical nurses, as well as Andrew Reid, a simulation consultant with Alberta Heath Services.
“We select available HeartWorks TEE pathologies corresponding to clinical emergencies which may be encountered during or after cardiac surgical procedures. These can include scenarios such as right coronary air with acute right heart failure, iatrogenic aortic dissection, acute graft failure, and protamine reactions. We then run the simulations using Dr. White’s porcine models with a modified extracorporeal membranous oxygenation circuit to simulate cardiopulmonary bypass.” Surita Sidhu MD, FRCP(C), FASE, Clinical Professor, Anesthesiology and Pain Medicine.
“The anesthesia and surgical trainees become so immersed in the simulation experience that they react very similarly to it being an actual clinical scenario. However, because it is a simulation, we are able to deconstruct both clinical management and communication skills in a stepwise fashion during the post-simulation debrief.” Surita Sidhu MD, FRCP(C), FASE, Clinical Professor, Anesthesiology and Pain Medicine.
Many programs currently use simulation in isolation, but this new approach may allow training programs to further augment their internal training to include cardiac surgical scenarios. Heartworks allows realistic training in a safe, controlled environment on 30 pathology cases. The full cardiac learning pathway guides students from basic probe-manipulation skills to on-system assessment and active scenarios.
Hi-fidelity ultrasound simulators for Transesophageal and Transthoracic Echocardiography (TTE & TEE).