The Cardiac Surgery Advanced Life Support Course (CALS): delivering significant improvements in emergency cardiothoracic care.
BACKGROUND
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.


METHODS
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.


RESULTS
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).


CONCLUSIONS
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.
Dunning
Joel
J
Department of Cardiothoracic Surgery, James Cook University Hospital, Middlesbrough, United Kingdom. joeldunning@doctors.org.uk
Nandi
Jay
J
Ariffin
Sharil
S
Jerstice
John
J
Danitsch
Deborah
D
Levine
Adrian
A
D016887:Cardiopulmonary Resuscitation / Q000193:education*; D002983:Clinical Competence; D002985:Clinical Protocols; D016638:Critical Illness; D004638:Emergency Treatment; D006323:Heart Arrest / Q000601:surgery / Q000628:therapy*; D006331:Heart Diseases / Q000601:surgery; D006801:Humans; D008020:Life Support Care; D008348:Manikins; D011787:Quality of Health Care; D012140:Respiratory Tract Diseases / Q000601:surgery; D013663:Teaching / Q000379:methods*