Managing a Surgical Exsanguination Emergency in the Operating Room Through Simulation: An Interdisciplinary Approach

• Published in: Journal of surgical education 2012-11, Vol.69 (6), p.759-765
• Main Authors: Acero, Natalia Martinez, MD, Motuk, Gregory, RN, Luba, Josef, RN, Murphy, Michael, MSN, McKelvey, Susan, RN, Kolb, Gretchen, MS, Dumon, Kristoffel R., MD, Resnick, Andrew S., MD
• Format: Article
• Language: English
• Subjects: Emergencies; emergency; Exsanguination; Female; Humans; Interdisciplinary Communication; Internship and Residency; Interpersonal and Communication Skills; operating room; Operating Rooms; Patient Care; Practice Based Learning and Improvement; Pregnancy; Prospective Studies; simulation; Specialties, Surgical - education; Surgery; team training
• ISSN: 1931-7204; 1878-7452
• DOI: 10.1016/j.jsurg.2012.06.022

Objective Operating room (OR) emergencies, such as fire, anaphylaxis, cardiac arrest, and exsanguination, are infrequent, but high-risk situations that can result in significant morbidity and mortality. An exsanguination scenario involving a pregnant trauma patient in the OR was developed for surgery residents with the objectives of improving overall team performance when activating an emergency response system, identifying a team leader, initiating an exsanguination protocol, following advanced cardiac life support guidelines, and recognizing the mother as the first patient. Study Design During 6 months, 171 OR staff members of the Hospital of the University of Pennsylvania participated in a prospective study in which randomly selected groups of surgery residents, anesthesia residents, and perioperative nurses were trained in a simulated exsanguination and cardiac arrest emergency. Upon arrival to the simulation center, groups of trainees were assigned to a simulated OR equipped with a SimMan 3G (Laerdal, Norway) and a session moderator. The scenario started with a pregnant patient in hemorrhagic shock, bleeding from a carotid injury, ultimately leading to cardiac arrest. Each group did an initial “cold” simulation without any prior training or knowledge of the scenario, followed by a didactic training session, and ending with a “warm” simulation. Setting Penn Medicine Clinical Simulation Center at 1800 Lombard Street, Philadelphia, Pennsylvania. Results Among 156 participants, 50% reported understanding their role in an OR exsanguination emergency pretraining, compared with 98% who understood it posttraining (p < 0.001). For activation of the exsanguination protocol, 50% understood how to do it pretraining, compared with 98% posttraining (p = 0.004). The time needed to complete 8 clinically significant tasks was documented pre- and posttraining, with a statistically significant improvement in all tasks. Conclusions The results of this simulated exsanguination emergency demonstrate that team training using a high-fidelity mannequin is an effective way to train OR personnel, on how to manage exsanguinating traumatic patients in a high-risk surgical emergency.