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Enhancing Cardiac Arrest Outcomes Through Advanced Life Support Education in Post-Cardiac Surgery Patients: An InterdisciplinaryApproach to Implementation and Quality Improvement
Jennifer Peterson1, Jenelle Badulak1, Jordan Surrusco1, Janet Regan-Baggs1, Megan Robinson1, Ruth Rogers1, Joel Green1, Jenny Garnett1, Kailey Sparks1, Melissa Cullen1, Angela Pal2, Aaron M. Cheng1, *Jay Pal1
1University of Washington, Seattle, Washington, United States, 2University of Colorado System, Denver, Colorado, United States
Objective
Cardiac arrest in patients following cardiac surgery presents distinct challenges from those encountered in out-of-hospital cardiac arrest scenarios. Standard Advanced Cardiac Life Support (ACLS) protocols may not adequately address these complexities, necessitating specialized training in Cardiac Advanced Life Support (CALS), which focuses on the immediate recognition and management of complications unique to the post-cardiac surgery patient. We implemented a CALS code process to improve post-arrest outcomes in this patient cohort.
Methods
This study evaluated the impact of an interdisciplinary CALS education program designed to enhance the knowledge and response capabilities of healthcare providers in a cardiac surgical setting. The program incorporated didactic sessions, high-fidelity simulation exercises, and pre- and post-training assessments. Registered nurses, advanced practice providers, critical care physicians, and cardiac surgeons received comprehensive didactic content covering post-cardiac surgery arrest, critical differences between CALS and standard ACLS, and specific resuscitative interventions. This was followed by high-fidelity simulation training, allowing participants to practice the CALS protocol in a controlled, realistic, critical care environment. Simulation scenarios included the management of postoperative complications and emergent re-sternotomy of cardiac surgery patients. After completion of team training, outcomes were tracked for postoperative cardiac surgery patients for whom CALS code process was implemented.
Results
A total of 141 participants completed the didactic education, interdisciplinary simulation training, and pre- and post-training surveys (59 providers, 73 nurses/respiratory therapists, and 9 pharmacists). On a 5-point Likert scale, confidence in the CALS response improved amongst all participants. Providers improved from a mean score of 3.1(SD 1.1) pre-training to 4.24 (SD 0.7) on the post-training survey; RN/RT confidence improved from 3.1 (0.8) to 4.1(0.8). On the knowledge questions, mean provider scores improved from 85% to 95% pre- to post-training assessment, while mean RN/RT accuracy improved from 80% to 90%. In the post-implementation period, 75% of patients survived the code event, compared to 65% in the pre-implementation period.
Conclusions
The implementation of a CALS-focused educational program that includes high-fidelity simulation training significantly improves the preparedness of interdisciplinary teams to manage cardiac arrests in post-cardiac surgery patients. By enhancing both the knowledge base and practical skills of healthcare providers, CALS training leads to more efficient and effective team-based resuscitative efforts, ultimately improving patient rescue in this high-risk population.
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