Development of a porcine model of emergency resternotomy at a low-volume cardiac surgery centre

Abstract

Emergency resternotomy in the intensive care unit (ICU) is a rarely performed, yet potentially life-saving intervention. Success relies on recognition of a deteriorating clinical condition, timely deployment of equipment/personnel and rapid execution. Given how infrequently it is performed, we sought to develop a large animal model of resternotomy to prepare ICU nurses and technicians at our low-volume cardiac surgery military centre. A porcine model of resternotomy was developed at the end of an already-scheduled trauma lab. Participants worked their way through a pre-planned simulation scenario, culminating in the need for resternotomy. Pre-simulation surveys assessing knowledge and comfort level with aspects of resternotomy were compared to post-simulation surveys. Participants improved their knowledge of resternotomy by 20.4% (P < 0.0001; 14.7% for nurses and 26.9% for technicians). Improvements were seen in all aspects assessed relating to subjective comfort/preparedness of resternotomy. The model was an effective and realistic method to augment training of ICU staff about resternotomy. Costs associated with this model can be reduced when used in conjunction with large animal labs. This model should be used together with mannequin-based methods of resternotomy training to provide a realistic training environment and assessment of skills at capable institutions.

Increase Intensive Care Staff Comfort and Proficiency With Emergent Re-sternotomy in the Post-Open-Heart Patient by Using SynDaver® Simulation

“…The results obtained from this project were statistically comparable to other published results. The previously identified gaps in staff training were addressed by the use of simulation, whether it be low versus high fidelity [ 1 , 5 , 6 ].…”

“…Simulation-based training has become a basic standard in the medical field for training medical staff in procedures from the basic to the more advanced medical procedures. Simulation is also used to train medical staff in low-volume, high-risk techniques in the hopes that they will never have to perform an emergent re-sternotomy [ 1 , 2 ]. Still, if they must, they will at least have some level of familiarity with the procedure.…”

Emergent Bedside Resternotomy: An Innovative Simulation Model for Training Pediatric Cardiac Intensive Care Teams

“…The few existing resternotomy simulation studies are predominantly geared toward training for adult postoperative resuscitation, thus leaving a significant knowledge gap for approaching the pediatric population. 25,26 Of those studies investigating pediatric CICU resuscitation simulation, the realism of the mannequin appears to be a significant limita-tion. 27,28 We believe our novel pediatric mannequin added a unique degree of situational fidelity to the training process.…”