Authors: David John Melia, Richard Pieter Ruberti, Kimberley Smith, Sarah Emily Owen

 In Original Article

Abstract

Objective: To characterise the out-of-hours cover of Cardiac-Surgical Intensive Care Units in Australia, the experience of covering physicians in the training, and management of, cardiac arrest after cardiac surgery, and to describe a novel educational course.

Design: Nighttime phone survey with doctors on public cardiac intensive care units across Australia. Members of nursing, intensive care, and cardiac surgery staff, devised a dedicated half-day course to address the principles of managing a cardiac arrest post-cardiac surgery.

Setting: Tertiary teaching hospital in Sydney, New South Wales, Australia.

Patients and Participants: No patient data used. Qualitative and quantitative feedback from doctors covering intensive care units, and participants, on a pilot course designed to formally train medical and nursing personnel in the management of cardiac arrest after cardiac surgery.

Interventions: Design and implementation of a new training course.

Measurements and Results: We demonstrated wide variation in the availability of training opportunities in Cardiac-surgical Unit-Advanced Life Support, with few units having cardiothoracic surgical doctors on site at night, and the majority of units being covered by a registrar grade, intensive care trainee, out-of-hours. Our pilot course was feasible, well received, and demonstrated improvements in candidates’ confidence in managing cardiac arrests, and their ability to perform, or assist with, emergency re-sternotomy.

Conclusions: The experience of doctors covering cardiac intensive care units varies greatly. There is a lack of dedicated guidelines covering the management of cardiac arrest in the post-cardiac surgical population, with wide variability in whether institutions offer training for this emergency, and how frequently these opportunities are available. There is also a lack of trained medical staff on-site, out-of-hours, able to perform emergency re-sternotomy.

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