Dunning Joel, Nandi Jay, Ariffin Sharil, Jerstice John, Danitsch Deborah, Levine Adrian
Department of Cardiothoracic Surgery, James Cook University Hospital, Middlesbrough, United Kingdom.
Ann Thorac Surg. 2006 May;81(5):1767-72. doi: 10.1016/j.athoracsur.2005.12.012.
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.
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.
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).
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.
设计了一个为期3天的心脏手术高级生命支持课程，包含一系列用于管理重症心脏手术患者和心脏骤停患者的方案。我们试图确定该课程对模拟重症和心脏骤停患者管理的影响。
24名学员参加了该课程。使用插管人体模型模拟重症患者，模型带有原位的管路和引流管，以及一台装有重症监护病房监测模拟程序的笔记本电脑。在课程前后，学员们接受了严格预先设计的临床情景测试。学员们被分成6人一组，以同样的方式模拟心脏骤停，所有所需的手术设备随时可用。所有场景都被录像，在不知情的情况下，由一名独立的外科医生评估达到预定临床终点的时间。
对于重症患者情景，课程结束后成功进行确定性治疗的时间显著加快：（课程前为565秒[标准差27秒]，课程后为303秒[标准差24秒]；p<0.0005）。此外，在课程后的情景中，实现一系列预定目标所需的时间也显著加快，这些目标包括气道检查、评估呼吸、循环评估、吸氧治疗、适当的循环治疗以及要求进行血气分析、胸部X光检查和心电图检查。心脏骤停患者成功开胸和进行心脏内部按摩的时间也显著缩短：（课程前为451秒[标准差39秒]，课程后为228秒[标准差17秒]；p = 0.011）。
对重症心脏手术患者和心脏骤停患者管理进行结构化培训和实践可显著提高这些患者的护理速度和质量。
