Simulation in Perioperative Liver Transplant Anesthesia: A Systematic Review

Abstract

Due to the complexity of liver transplant patients and the variability in exposure to transplantation by anesthesia trainees, simulation is often required as an adjunct to clinical experience. This systematic review identifies current simulation models in the literature that pertain to perioperative liver transplant anesthesia. Data were collected by performing an electronic search of the PubMed and Scopus databases for articles describing simulation in transplant anesthesia. Abstracts were screened using the preferred reporting items for systematic reviews and meta-analysis (PRISMA) guidelines. Three reviewers analyzed 16 abstracts found in the search and agreed upon articles that met the inclusion criteria for the systematic review. A total of five publications met the inclusion criteria; they could be grouped as cognitive skills and technical skills simulators. Cognitive skills simulators utilized high-fidelity mannequins and animal models combined with traditional educational material to enhance pattern recognition of critical complications during liver transplantation. One manuscript focused on a technical skills acquisition by utilizing transesophageal echocardiography (TEE) to identify intraoperative pathologies. There is a heterogeneity in the exposure to liver transplant care during anesthesia training. Simulation provides low-stakes exposure to the high-stakes skills required in the operating room. Hence, it can be used as an adjunct to improve both cognitive and technical skill acquisition for perioperative transplant anesthesia. The goal of these simulation programs is to improve patient outcomes and produce more capable anesthesiologists.

International Liver Transplantation Society/Society for Advancement of Transplant Anesthesia Consensus Statement on Essential Attributes of a Liver Transplant Anesthesiologist

“…These defined training objectives can help guide fellows in their consumption and utilization of a myriad of educational tools currently available for LT anesthesia training. These include online educational resources from international societies, interactive live webinars using video-conferencing, simulation-based training, 27 and hybrid medical conferences.…”

The use of simulation in liver transplantation anesthesiology fellowship training: A survey of fellowship program directors in the United States

“…Examples include high‐fidelity simulators (interactive mannequin‐based simulation with programmable vitals and pathologies), cadaveric/meat models, partial task trainers (limited tools to learn focused skills, such as central line insertion), serious gaming (video games with educational objectives), and screen‐based simulators (e.g., transesophageal echocardiography (TEE) simulators) 3–5 . A recent systematic review identified several modalities that are used for teaching perioperative management of patients with end‐stage liver disease, including mannequin‐based simulation, serious gaming, and partial task trainer simulation 6 . While each simulation modality provides unique strengths and weaknesses to the learner, no single modality is known to be superior in educating trainees on liver transplantation anesthesia.…”

“…Although prior reviews have shown the utility of simulation in liver transplantation anesthesiology, 6 including the use of high‐fidelity simulation 7 and serious gaming, 8 no recent study has surveyed training programs to explore the specific use of simulation during fellowship training. We aimed to describe the current landscape of simulation by liver transplantation anesthesiology fellowship programs as a means of identifying commonly used high‐yield simulation modalities and the limitations of their use.…”

“…[3][4][5] A recent systematic review identified several modalities that are used for teaching perioperative management of patients with end-stage liver disease, including mannequin-based simulation, serious gaming, and partial task trainer simulation. 6 While each simulation modality provides unique strengths and weaknesses to the learner, no single modality is known to be superior in educating trainees on liver transplantation anesthesia.…”