Abdelghafar Moslem, Abdelmoneim Taher, Mohamed Alaa, Abdalla Mohamed
Department of Cardiothoracic Surgery, Wythenshawe Hospital, Manchester, UK.
Department of Cardiac Surgery, National Heart Institute, Giza, Egypt.
Cardiothorac Surg. 2022;30(1):6. doi: 10.1186/s43057-022-00067-6. Epub 2022 Feb 7.
Cardiac surgery patients have different resuscitative needs than other patients who experience in-hospital cardiac arrest; this was addressed in the guidelines. However, it is unknown how widely the guidelines are practiced, or a training protocol is followed in different cardiac surgery units in Egypt.
A 21-question survey was created and included: Participant demographics, prevalence of cardiac arrest, cardiac arrest protocol, emergency resternotomy technique, training protocols. Survey was disseminated through social media messaging platforms during the period between November 2020 and January 2021.
Ninety-five responses were from 11 centres across Egypt. In total, 68.5% of the respondents were surgeons, 76.8% of participants were junior surgeons. For patients who go into VF after cardiac surgery, respondents would attempt a median of 3 shocks with only 24.2% commencing defibrillation shocks before external cardiac massage, whilst the majority initiating CPR immediately and performing emergency resternotomy in a median time of 10 min. In total, 56.8% would give 1 mg of adrenaline as soon as the cardiac arrest was established. If a surgeon was not available, only 36.8% of respondents would allow any trained personnel to perform the emergency resternotomy. Only 9.5% practice regularly on emergency sternotomies. Seventy-five percent think tailored training is important and staff should be oriented about it in the future.
An action plan is required to improve the training of the junior surgeons regarding the Cardiac Advanced Life Support Protocol to implement it in a timely organised manner. This should be endorsed and audited by a national society or body by keeping a national registry and mandatory recertification.
心脏手术患者的复苏需求与其他发生院内心脏骤停的患者不同；指南中对此有阐述。然而，尚不清楚这些指南在埃及不同心脏手术科室的执行范围有多广，或者是否遵循了培训方案。
设计了一份包含21个问题的调查问卷，内容包括：参与者的人口统计学信息、心脏骤停的发生率、心脏骤停处理方案、紧急胸骨切开术技术、培训方案。该调查问卷于2020年11月至2021年1月期间通过社交媒体信息平台进行分发。
来自埃及11个中心的95人回复了问卷。总体而言，68.5%的受访者为外科医生，76.8%的参与者为初级外科医生。对于心脏手术后发生室颤的患者，受访者尝试电击的中位数为3次，只有24.2%的人在进行体外心脏按压前开始电击除颤，而大多数人立即开始心肺复苏，并在中位数时间10分钟内进行紧急胸骨切开术。总共56.8%的人会在心脏骤停确诊后立即给予1毫克肾上腺素。如果没有外科医生在场，只有36.8%的受访者会允许任何经过培训的人员进行紧急胸骨切开术。只有9.5%的人定期进行紧急胸骨切开术练习。75%的人认为针对性培训很重要，未来应让工作人员了解这一点。
需要制定一项行动计划，以改善初级外科医生在心脏高级生命支持方案方面的培训，以便及时、有组织地实施该方案。这应由国家协会或机构认可并审核，建立国家登记册并进行强制再认证。
