Incident-simulating device with wireless control for extracorporeal circulation crisis management drills

Use of an extracorporeal circulation perfusion simulator: evaluation of its accuracy and repeatability

Medical simulators have mainly been used as educational tools. They have been used to train technicians and to educate potential users about safety. We combined software for hybrid-type extracorporeal circulation simulation (ECCSIM) with a CPB-Workshop console. We evaluated the performance of ECCSIM, including its accuracy and repeatability, during simulated ECC. We performed a detailed evaluation of the synchronization of the software with the console and the function of the built-in valves. An S-III heart–lung machine was used for the open circuit. It included a venous reservoir, an oxygenator (RX-25), and an arterial filter. The tubes for venous drainage and the arterial line were connected directly to the ports of the console. The ECCSIM recorded the liquid level of the reservoir continuously. The valve in the console controlled the pressure load of the arterial line. The software made any adjustments necessary to both arterial pressure load and the venous drainage flow volume. No external flowmeters were necessary during simulation. We found the CPB-Workshop to be convenient, reliable, and sufficiently exact. It can be used to validate procedures by monitoring the controls and responses by using a combination of qualitative measures.

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.

Perfusion safety: new initiatives and enduring principles

Perfusion safety has been studied and discussed extensively for decades. Many initiatives occurred through efforts of professional organizations to achieve recognition, establish accreditation and certification, promote consensus practice guidelines, and develop peer-reviewed journals as sources for dissemination of clinical information. Newer initiatives have their basis in other disciplines and include systems approach, Quality Assurance/Quality Improvement processes, error recognition, evidence-based methodologies, registries, equipment automation, simulation, and the Internet. Use of previously established resources such as written protocols, checklists, safety devices, and enhanced communication skills has persisted to the present in promoting perfusion safety and has reduced current complication rates to negligible levels.

Crisis in the operating room: fires, explosions and electrical accidents

Fires, explosions and electrical accidents in the operating theater are rare events, but are devastating in terms of structural damage to the equipment in theaters and to human lives. While various circumstances lead to these troubles, we can avoid and manage them by learning from the instructive cases accumulated so far. We describe operating room crises such as fires, explosions and electrical breakdowns, and discuss causes and countermeasures.