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Nolan JP, Soar J, Kane AD, Moppett IK, Armstrong RA, Kursumovic E, Cook TM. Peri-operative decisions about cardiopulmonary resuscitation among adults as reported to the 7th National Audit Project of the Royal College of Anaesthetists. Anaesthesia 2024; 79:186-192. [PMID: 37991058 DOI: 10.1111/anae.16179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/17/2023] [Indexed: 11/23/2023]
Abstract
Current guidance recommends that, in most circumstances, cardiopulmonary resuscitation should be attempted when cardiac arrest occurs during anaesthesia, and when a patient has a pre-existing 'do not attempt cardiopulmonary resuscitation' recommendation, this should be suspended. How this guidance is translated into everyday clinical practice in the UK is currently unknown. Here, as part of the 7th National Audit Project of the Royal College of Anaesthetists, we have: assessed the rates of pre-operative 'do not attempt cardiopulmonary resuscitation' recommendations via an activity survey of all cases undertaken by anaesthetists over four days in each participating site; and analysed our one-year case registry of peri-operative cardiac arrests to understand the rates of cardiac arrest in patients who had 'do not attempt cardiopulmonary resuscitation' decisions pre-operatively. In the activity survey, among 20,717 adults (aged > 18 y) undergoing surgery, 595 (3%) had a 'do not attempt cardiopulmonary resuscitation' recommendation pre-operatively, of which less than a third (175, 29%) were suspended. Of the 881 peri-operative cardiac arrest reports, 54 (6%) patients had a 'do not attempt cardiopulmonary resuscitation' recommendation made pre-operatively and of these 38 (70%) had a clinical frailty scale score ≥ 5. Just under half (25, 46%) of these 'do not attempt cardiopulmonary resuscitation' recommendations were formally suspended at the time of anaesthesia and surgery. One in five of these patients with a 'do not attempt cardiopulmonary resuscitation' recommendation who had a cardiac arrest survived to leave hospital and of the seven patients with documented modified Rankin Scale scores before and after cardiac arrest, four remained the same and three had worse scores. Very few patients who had a pre-existing 'do not attempt cardiopulmonary resuscitation' recommendation had a peri-operative cardiac arrest, and when cardiac arrest did occur, return of spontaneous circulation was achieved in 57%, although > 50% of these patients subsequently died before discharge from hospital.
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Affiliation(s)
- J P Nolan
- Warwick Clinical Trials Unit, University of Warwick, UK
- Department of Anaesthesia and Intensive Care Medicine, Royal United Hospitals Bath NHS Foundation Trust, Bath, UK
| | - J Soar
- Department of Anaesthesia and Intensive Care Medicine, Southmead Hospital, Bristol, UK
| | - A D Kane
- Health Services Research Centre, Royal College of Anaesthetists, Red Lion Square, UK
- Department of Anaesthesia, James Cook University Hospital, South Tees NHS Foundation Trust, Middlesbrough, UK
| | - I K Moppett
- Health Services Research Centre, Royal College of Anaesthetists, Red Lion Square, UK
- University of Nottingham, Nottingham, UK
| | - R A Armstrong
- Health Services Research Centre, Royal College of Anaesthetists, Red Lion Square, UK
- Severn Deanery, Bristol, UK
| | - E Kursumovic
- Department of Anaesthesia and Intensive Care Medicine, Royal United Hospitals Bath NHS Foundation Trust, Bath, UK
- Health Services Research Centre, Royal College of Anaesthetists, Red Lion Square, UK
| | - T M Cook
- Department of Anaesthesia and Intensive Care Medicine, Royal United Hospitals Bath NHS Foundation Trust, Bath, UK
- University of Bristol, Bristol, UK
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2
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Hinkelbein J, Andres J, Böttiger BW, Brazzi L, De Robertis E, Einav S, Gwinnutt C, Kuvaki B, Krawczyk P, McEvoy MD, Mertens P, Moitra VK, Navarro-Martinez J, Nunnally ME, O Connor M, Rall M, Ruetzler K, Schmitz J, Thies K, Tilsed J, Zago M, Afshari A. Cardiac arrest in the perioperative period: a consensus guideline for identification, treatment, and prevention from the European Society of Anaesthesiology and Intensive Care and the European Society for Trauma and Emergency Surgery. Eur J Trauma Emerg Surg 2023; 49:2031-2046. [PMID: 37430174 PMCID: PMC10520188 DOI: 10.1007/s00068-023-02271-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/12/2023]
Abstract
INTRODUCTION Cardiac arrest in the operating room is a rare but potentially life-threatening event with mortality rates of more than 50%. Contributing factors are often known, and the event is recognised rapidly as patients are usually under full monitoring. This guideline covers the perioperative period and is complementary to the European Resuscitation Council guidelines. MATERIAL AND METHODS The European Society of Anaesthesiology and Intensive Care and the European Society for Trauma and Emergency Surgery jointly nominated a panel of experts to develop guidelines for the recognition, treatment, and prevention of cardiac arrest in the perioperative period. A literature search was conducted in MEDLINE, EMBASE, CINAHL and the Cochrane Central Register of Controlled Trials. All searches were restricted to publications from 1980 to 2019 inclusive and to the English, French, Italian and Spanish languages. The authors also contributed individual, independent literature searches. RESULTS This guideline contains background information and recommendation for the treatment of cardiac arrest in the operating room environment, and addresses controversial topics such as open chest cardiac massage, resuscitative endovascular balloon occlusion and resuscitative thoracotomy, pericardiocentesis, needle decompression, and thoracostomy. CONCLUSIONS Successful prevention and management of cardiac arrest during anaesthesia and surgery requires anticipation, early recognition, and a clear treatment plan. The ready availability of expert staff and equipment must also be taken into consideration. Success not only depends on medical knowledge, technical skills and a well-organised team using crew resource management, but also on an institutional safety culture embedded in everyday practice through continuous education, training, and multidisciplinary co-operation.
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Affiliation(s)
- Jochen Hinkelbein
- Department of Anaesthesiology, Intensive Care Medicine and Emergency Medicine, Johannes Wesling Klinikum Minden, Ruhr-University Bochum, Minden, Germany.
| | - Janusz Andres
- Department of Anaesthesiology and Intensive Therapy, Jagiellonian University Medical College, Krakow, Poland
| | - Bernd W Böttiger
- Department of Anaesthesiology and Intensive Care Medicine, Medical Faculty, University Hospital of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - Luca Brazzi
- The Department of Surgical Sciences, University of Turin, Turin, Italy
| | - Edoardo De Robertis
- The Division of Anaesthesia, Analgesia and Intensive Care, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Sharon Einav
- The Intensive Care Unit, Shaare Zedek Medical Center, Hebrew University Faculty of Medicine, Jerusalem, Israel
| | - Carl Gwinnutt
- The Department of Anaesthesia, Salford Royal NHS Foundation Trust, Salford, UK
| | - Bahar Kuvaki
- The Department of Anesthesiology and Reanimation, Dokuz Eylül University, İzmir, Turkey
| | - Pawel Krawczyk
- The Department of Anesthesiology and Intensive Care Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Matthew D McEvoy
- The Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Pieter Mertens
- The Department of Anaesthesiology, Antwerp University Hospital, Drie Eikenstraat 655, 2650, Edegem, Belgium
| | - Vivek K Moitra
- Division of Critical Care Anesthesiology, The Department of Anesthesiology, Columbia University, Columbia, NY, USA
| | - Jose Navarro-Martinez
- The Anesthesiology Department, Dr. Balmis General University Hospital, Alicante Institute for Health and Biomedical Research (ISAB), Biomedical Research (ISABIAL), Alicante, Spain
| | - Mark E Nunnally
- The Department of Anesthesiology, Perioperative Care, and Pain Medicine, NYU Grossman School of Medicine, New York, NY, USA
| | - Michael O Connor
- The Department of Anesthesiology & Critical Care, University of Chicago, Chicago, IL, USA
| | - Marcus Rall
- The Institute for Patient Safety and Simulation Team Training InPASS, Reutlingen, Germany
| | - Kurt Ruetzler
- The Departments of General Anesthesiology and Outcomes Research, Anesthesiology Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Jan Schmitz
- Department of Anaesthesiology and Intensive Care Medicine, Medical Faculty, University Hospital of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - Karl Thies
- The Department of Anaesthesiology and Critical Care, EvKB, OWL University Medical Center, Bielefeld University, Campus Bielefeld-Bethel, Bethel, Germany
| | - Jonathan Tilsed
- The Department of Surgery, Hull University Teaching Hospitals, Hull, UK
| | - Mauro Zago
- General & Emergency Surgery Division, The Department of Surgery, A. Manzoni Hospital, Milan, Italy
| | - Arash Afshari
- The Department of Paediatric and Obstetric Anaesthesia, Copenhagen University Hospital, Rigshospitalet, Denmark
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3
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Hinkelbein J, Andres J, Böttiger BW, Brazzi L, De Robertis E, Einav S, Gwinnutt C, Kuvaki B, Krawczyk P, McEvoy MD, Mertens P, Moitra VK, Navarro-Martinez J, Nunnally ME, O'Connor M, Rall M, Ruetzler K, Schmitz J, Thies K, Tilsed J, Zago M, Afshari A. Cardiac arrest in the perioperative period: a consensus guideline for identification, treatment, and prevention from the European Society of Anaesthesiology and Intensive Care and the European Society for Trauma and Emergency Surgery. Eur J Anaesthesiol 2023; 40:724-736. [PMID: 37218626 DOI: 10.1097/eja.0000000000001813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
INTRODUCTION Cardiac arrest in the operating room is a rare but potentially life-threatening event with mortality rates of more than 50%. Contributing factors are often known, and the event is recognised rapidly as patients are usually under full monitoring. This guideline covers the perioperative period and is complementary to the European Resuscitation Council (ERC) guidelines. MATERIAL AND METHODS The European Society of Anaesthesiology and Intensive Care and the European Society for Trauma and Emergency Surgery jointly nominated a panel of experts to develop guidelines for the recognition, treatment and prevention of cardiac arrest in the perioperative period. A literature search was conducted in MEDLINE, EMBASE, CINAHL and the Cochrane Central Register of Controlled Trials. All searches were restricted to publications from 1980 to 2019 inclusive and to the English, French, Italian and Spanish languages. The authors also contributed individual, independent literature searches. RESULTS This guideline contains background information and recommendation for the treatment of cardiac arrest in the operating room environment, and addresses controversial topics such as open chest cardiac massage (OCCM), resuscitative endovascular balloon occlusion (REBOA) and resuscitative thoracotomy, pericardiocentesis, needle decompression and thoracostomy. CONCLUSION Successful prevention and management of cardiac arrest during anaesthesia and surgery requires anticipation, early recognition and a clear treatment plan. The ready availability of expert staff and equipment must also be taken into consideration. Success not only depends on medical knowledge, technical skills and a well organised team using crew resource management but also on an institutional safety culture embedded in everyday practice through continuous education, training and multidisciplinary co-operation.
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Affiliation(s)
- Jochen Hinkelbein
- From the University Department of Anaesthesiology, Intensive Care Medicine and Emergency Medicine, Johannes Wesling Klinikum Minden, University Hospital Ruhr-University Bochum, Minden, Germany (JH), Department of Anaesthesiology and Intensive Care Medicine, Medical Faculty and University Hospital of Cologne, Cologne, Germany (BWB, JS), Department of Anaesthesiology and Intensive Therapy, Jagiellonian University Medical College, Krakow, Poland (JA), Department of Surgical Sciences, University of Turin, Turin (LB), Division of Anaesthesia, Analgesia and Intensive Care, Department of Medicine and Surgery, University of Perugia, Italy (EdR), Intensive Care Unit, Shaare Zedek Medical Center and Hebrew University Faculty of Medicine, Jerusalem, Israel (SE), Department of Anaesthesia, Salford Royal NHS Foundation Trust, Salford, UK (CG), Department of Anesthesiology and Reanimation, Dokuz Eylül University, İzmir, Turkey (BK), Department of Anesthesiology and Intensive Care Medicine, Jagiellonian University Medical College, Krakow, Poland (PK), Department of Anaesthesiology, Antwerp University Hospital, Edegem, Belgium (PM), Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee (MDM), Division of Critical Care Anesthesiology, Department of Anesthesiology, Columbia University, New York, USA (VKM), Anesthesiology Department, Dr Balmis General University Hospital, Alicante Institute for Health and Biomedical Research (ISAB), and Biomedical Research (ISABIAL), Alicante, Spain (JN-M), Department of Anesthesiology, Perioperative Care, and Pain Medicine, NYU Grossman School of Medicine, New York (MEN), Department of Anesthesiology & Critical Care, University of Chicago, Illinois, USA (MO'C), Institute for Patient Safety and Simulation Team Training InPASS, Reutlingen, Germany (MR), Departments of General Anesthesiology and Outcomes Research, Anesthesiology Institute, Cleveland Clinic, Cleveland, Ohio, USA (KR), Department of Anaesthesiology and Critical Care, EvKB, OWL University Medical Center, Bielefeld University, Campus Bielefeld-Bethel, Germany (KT), Department of Surgery, Hull University Teaching Hospitals, Hull, UK (JT), General & Emergency Surgery Division, Department of Surgery, A. Manzoni Hospital, Milan, Italy (MZ) and Department of Paediatric and Obstetric Anaesthesia, Juliane Marie Centre, Rigshospitalet, Denmark and Department of Clinical Medicine, University of Copenhagen, Denmark (AA)
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4
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Do Not Attempt Resuscitation in the Operating Room: A Misconstrued Paradox? J Am Coll Surg 2022; 234:953-957. [DOI: 10.1097/xcs.0000000000000116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Beyond the Do-not-resuscitate Order: An Expanded Approach to Decision-making Regarding Cardiopulmonary Resuscitation in Older Surgical Patients. Anesthesiology 2021; 135:781-787. [PMID: 34499085 DOI: 10.1097/aln.0000000000003937] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
American Society of Anesthesiologists guidelines recommend that anesthesiologists revisit do-not-resuscitate orders preoperatively and revise them if necessary based on patient preferences. In patients without do-not-resuscitate orders or other directives limiting treatment however, "full code" is the default option irrespective of clinical circumstances and patient preferences. It is time to revisit this approach based on (1) increasing understanding of the power of default options in healthcare settings, (2) changing demographics and growing evidence suggesting that an expanding subset of patients is vulnerable to poor outcomes after perioperative cardiopulmonary resuscitation (CPR), and (3) recommendations from multiple societies promoting risk assessment and goal-concordant care in older surgical patients. The authors reconsider current guidelines in the context of these developments and advocate for an expanded approach to decision-making regarding CPR, which involves identifying high-risk elderly patients and eliciting their preferences regarding CPR irrespective of existing or presumed code status.
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O'Leary S, Pimentel MP, Ford S, Vacanti JC, Bleday R, Salmasian H, Mendu ML. Perioperative Code Status Discussions: How Are We Doing? A A Pract 2021; 15:e01473. [PMID: 34043591 DOI: 10.1213/xaa.0000000000001473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Approximately 15% of patients with a code status of do-not-resuscitate (DNR) or do-not-intubate (DNI) present for surgery. Despite professional guidelines requiring discussions with patients regarding perioperative resuscitation, it is unclear whether these recommendations are consistently followed. Our review of 158 patient encounters with established DNR/DNI code status found that code status discussions (CSDs) were documented only 70% of the time, and code status orders were inconsistently entered to reflect those discussions. We present solutions to improve CSD documentation, including refining perioperative workflows, simplifying code status choices, optimizing electronic health record order entry, and a supplementary consent form to facilitate code status review.
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Affiliation(s)
- Sian O'Leary
- From the Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Marc Philip Pimentel
- From the Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
- Department of Quality and Safety
| | - Shauna Ford
- Department of Analytics, Planning and Strategy Implementation, Brigham and Women's Hospital, Boston, Massachusetts
| | - Joshua C Vacanti
- From the Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Ronald Bleday
- Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Hojjat Salmasian
- From the Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
- Department of Analytics, Planning and Strategy Implementation, Brigham and Women's Hospital, Boston, Massachusetts
| | - Mallika L Mendu
- Department of Quality and Safety
- Renal Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
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Affiliation(s)
- Preeti R John
- Veterans Affairs (VA) Maryland Healthcare System, Department of Surgery, 186153University of Maryland School of Medicine, Baltimore, USA
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8
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Ruisch JE, Sipers W, Plum PF, Spaetgens B. Individualized approach to reconsider perioperative do-not-resuscitate orders in frail older patients. Geriatr Gerontol Int 2020; 20:989-990. [PMID: 33003252 PMCID: PMC7590086 DOI: 10.1111/ggi.14030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 08/16/2020] [Indexed: 12/04/2022]
Affiliation(s)
- Jessica E Ruisch
- Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands.,Department of Geriatric Medicine, Zuyderland Medical Center, Sittard-Geleen, The Netherlands
| | - Walther Sipers
- Department of Geriatric Medicine, Zuyderland Medical Center, Sittard-Geleen, The Netherlands
| | - P Frederik Plum
- Department of Geriatric Medicine, Zuyderland Medical Center, Sittard-Geleen, The Netherlands
| | - Bart Spaetgens
- Department of Internal Medicine, Division of General Internal Medicine, Section Geriatric Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
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Foong TW, Ramanathan K, Chan KKM, MacLaren G. Extracorporeal Membrane Oxygenation During Adult Noncardiac Surgery and Perioperative Emergencies: A Narrative Review. J Cardiothorac Vasc Anesth 2020; 35:281-297. [PMID: 32144062 DOI: 10.1053/j.jvca.2020.01.025] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2019] [Revised: 01/03/2020] [Accepted: 01/12/2020] [Indexed: 12/17/2022]
Abstract
Over the last decade, the use of extracorporeal membrane oxygenation (ECMO) has increased significantly. In some centers, ECMO has been deployed to manage perioperative emergencies and plays a role in facilitating high-risk thoracic, airway, and trauma surgery, which may not be feasible without ECMO support. General anesthesiologists who usually manage these cases may not be familiar with the initiation and management of patients on ECMO. This review discusses the use of ECMO in the operating room for thoracic, airway, and trauma surgery, as well as obstetric and perioperative emergencies.
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Affiliation(s)
- Theng Wai Foong
- Department of Anesthesia and Surgical Intensive Care Unit, National University Hospital, Singapore.
| | - Kollengode Ramanathan
- Cardiothoracic Intensive Care Unit, Department of Cardiothoracic and Vascular Surgery, National University Hospital, Singapore
| | - Kevin Kien Man Chan
- Department of Anesthesia and Surgical Intensive Care Unit, National University Hospital, Singapore
| | - Graeme MacLaren
- Cardiothoracic Intensive Care Unit, Department of Cardiothoracic and Vascular Surgery, National University Hospital, Singapore
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Hardin J, Forshier B. Adult Perianesthesia Do Not Resuscitate Orders: A Systematic Review. J Perianesth Nurs 2019; 34:1054-1068.e18. [PMID: 31230930 DOI: 10.1016/j.jopan.2019.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2019] [Revised: 03/12/2019] [Accepted: 03/23/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE The purpose of this systematic review is to assess if Do Not Resuscitate (DNR) orders should be routinely rescinded during anesthesia, determine if consensus on retaining DNR orders exists in the literature, and explore the current state of clinical practice. DESIGN This systematic review followed preferred reporting items for systematic reviews and meta-analyses guidelines. METHODS In June 2018, the Cumulative Index to Nursing and Allied Health Literature and PubMed databases were systematically searched using defined inclusion/exclusion criteria. FINDINGS Ninety-one articles from the databases were pooled with 16 works identified as formative to the research questions. Forty-nine articles were analyzed and included in this study. CONCLUSIONS It is unethical to automatically rescind DNR orders during anesthesia. Patients have the right to retain their DNR orders unaltered or modify them for the perianesthesia period. Sufficient evidence exists to create meaningful policy at every level. A consensus exists among professional organizations that the standard of care is a required reconsideration of DNR orders before anesthesia.
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Min JJ, Tay CK, Ryu DK, Wi W, Sung K, Lee YT, Cho YH, Lee JH. Extracorporeal cardiopulmonary resuscitation in refractory intra-operative cardiac arrest: an observational study of 12-year outcomes in a single tertiary hospital. Anaesthesia 2018; 73:1515-1523. [DOI: 10.1111/anae.14412] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/03/2018] [Indexed: 11/30/2022]
Affiliation(s)
- J. J. Min
- Department of Anaesthesiology and Pain Medicine; Department of Thoracic and Cardiovascular Surgery; Samsung Medical Centre; Sungkyukwan University School of Medicine; Seoul Korea
| | - C. K. Tay
- Department of Respiratory and Critical Care; Singapore General Hospital; Singapore
| | - D. K. Ryu
- Department of Anaesthesiology and Pain Medicine; Department of Thoracic and Cardiovascular Surgery; Samsung Medical Centre; Sungkyukwan University School of Medicine; Seoul Korea
| | - W. Wi
- Department of Anaesthesiology and Pain Medicine; Department of Thoracic and Cardiovascular Surgery; Samsung Medical Centre; Sungkyukwan University School of Medicine; Seoul Korea
| | - K. Sung
- Department of Thoracic and Cardiovascular Surgery; Samsung Medical Centre; Sungkyukwan University School of Medicine; Seoul Korea
| | - Y. T. Lee
- Department of Thoracic and Cardiovascular Surgery; Samsung Medical Centre; Sungkyukwan University School of Medicine; Seoul Korea
| | - Y. H. Cho
- Department of Thoracic and Cardiovascular Surgery; Samsung Medical Centre; Sungkyukwan University School of Medicine; Seoul Korea
| | - J.-H. Lee
- Department of Anaesthesiology and Pain Medicine; Department of Thoracic and Cardiovascular Surgery; Samsung Medical Centre; Sungkyukwan University School of Medicine; Seoul Korea
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Chanan E, Rollins MD. Adding to Our Competitive Advantage: Making the Case for Teaching Communication and Professionalism. Anesth Analg 2018; 127:580-585. [PMID: 29324499 DOI: 10.1213/ane.0000000000002737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Emily Chanan
- From the Department of Anesthesiology, Perioperative Care and Pain Medicine, New York University School of Medicine, New York, New York
| | - Mark D Rollins
- Departments of Anesthesia and Perioperative Care, Obstetrics-Gynecology and Surgery, University of California, San Francisco, California
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