Original article
Cardiovascular
The Cardiac Surgery Advanced Life Support Course (CALS): Delivering Significant Improvements in Emergency Cardiothoracic Care

https://doi.org/10.1016/j.athoracsur.2005.12.012Get rights and content

Background

A 3-day cardiac surgery advanced life support course was designed with a series of protocols to manage critically ill cardiac surgical patients and patients who suffer a cardiac arrest. We sought to determine the effect of this course on the management of simulated critically ill and cardiac arrest patients.

Methods

Twenty-four candidates participated in the course. Critically ill patients were simulated using intubated mannikins, with lines and drains in situ, and a laptop with an intensive care unit monitor simulation program. Candidates were tested before and after the course with rigidly predesigned clinical situations. Candidates were split into groups of 6, and cardiac arrests were simulated in the same fashion, with all required surgical equipment immediately available. All scenarios were videotaped, and after blinding, an independent surgeon assessed the times to achieve predetermined clinical endpoints.

Results

The time to successful definitive treatment was significantly faster postcourse for the critically ill patient scenarios: (565 secs [SD 27 secs] precourse, compared with 303 secs [SD 24 secs] postcourse; p < 0.0005). In addition, the times taken to achieve a wide range of predetermined objectives, including airway check, assessing breathing, circulation assessment, treating with oxygen, appropriate treatment of the circulation, and requesting blood gases, chest radiographs, and electrocardiograms, were also significantly faster in the postcourse scenarios. Times to successful chest reopening and internal cardiac massage were also significantly improved in cardiac arrest patients: (451 secs [SD 39 secs] precourse and 228 secs [SD 17 secs] postcourse; p = 0.011).

Conclusions

Structured training and practice in the management of critically ill cardiac surgical patients and patients suffering a cardiac arrest leads to significant improvements in the speed and quality of care for these patients.

Section snippets

Construction of Cardiac Surgical Unit Advanced Life Support (CALS) Course Protocols

A group of cardiothoracic surgeons and anaesthetists (J.D., S.A., J.J., A.L.) derived a series of protocols for the management of cardiac arrests or critical illness in cardiothoracic surgical patients, based on existing guidelines from Advanced Cardiac Life Support (ACLS), the European Resuscitation Council guidelines, publications from the cardiothoracic literature, and their own clinical experience. A protocol for patients who suffer a cardiac arrest was derived (see Fig 1, Fig 2). Further

Results

Eleven nurse practitioners, 8 senior house officers, 4 registrars, and 1 consultant from a total of 6 UK cardiothoracic units participated as candidates in this course. Two courses were run, each containing 12 candidates.

Comment

Numerous pressures on highly experienced cardiothoracic surgeons have led to great changes in the types of clinician called on to attend critically ill cardiothoracic patients. Anesthetic registrars, senior house officers, and increasingly, nurse practitioners are now called on to provide the initial assessment of potentially life-threatening situations. In addition, improvements in surgical technique and postoperative care means that cardiac arrest in the surgical intensive care is much less

References (10)

There are more references available in the full text version of this article.

Cited by (0)

View full text