| | DECEMBER - 20208UTLOOKHealthcare Tech IN MY OPINIONWhen Life is Measured in Minutes -- The Effect of Simulation on Outcomes of Cardiac ArrestBy LaWaun Hance, Director, Clinical Simulation Program for the Advancement of Patient Safety, St. Joseph Mercy Health SystemLaWaun Hance is the Director of Clinical Simulation Program for the Advancement of Patient Safety at St. Joseph Mercy Health System, Ann Arbor, Michigan. She possesses over 34 years of diverse experience in the field, mostly focused on her role as a Physician Assistant for Cardiothoracic Surgery and Clinical Coordinator for Surgical APPs. She graduated from Cornell University Medical College, New York in 1986.Simulation has long been used to practice individual skills in medicine. The healthcare simulation center is considered a "safe place" where such practice can occur in a controlled environment without placing patients at risk. Beyond individual skills, there is a growing interest for the use of simulation in team training -- particularly interdisciplinary team training, which helps bring participants out of their silos and improves communication skills. Good communication leads to reduced errors and efficient teamwork as well. Efficient teamwork is crucial to saving lives, particularly in settings where a patient's life is measured in minutes. Such critical situations are often rare events; simulation provides the opportunity to repeat such events in a practice setting until mastery by multiple providers is achieved. These scenarios then can be repeated at specified intervals as refresher practice to prevent degradation of skills over time. One example of a rare, high risk situation is the setting of cardiac arrest in a post-operative cardiac surgery patient. When this occurs, the patient can only be saved by rapid, highly skilled intervention, quite often when a cardiac surgeon is not immediately available. In the past, the protocols most often used in typical cardiac arrest situations (Advanced Cardiac Life Support -- ACLS) were applied to these patients, but these interventions are often ineffective and sometimes dangerous after open-heart surgery. Following years of focused research, new protocols for cardiac arrest after cardiac surgery were developed in the United Kingdom in 2003 and were adopted as a standard of care in Europe in 2010. The set of protocols, known as Cardiac Surgery Advanced Life Support (CALS in the U.K.) and Cardiac Surgical Unit Advance Life Support (CSU-ALS, NA) in North America, addresses postoperative decompensation and cardiogenic shock, emergency pacing, re-opening of the chest incision, open cardiac massage, and internal defibrillation. Training includes simulation for both individual skills and team performance, and is presented to clinicians in a 1-2 day course. Availability of the CSU-ALS course has gradually been increasing in the U.S. since 2012 and in 2017 was ratified by the Society of Thoracic Surgeons as standard of care.The Surgical ICU at St. Joseph Mercy Ann Arbor hospital has been offering training in CSU-ALS protocols internally LaWaun Hance
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