Simulation Case: Cardiac Arrest During Pediatric Posterior Spinal Fusion

Abstract

Abstract Introduction In this simulation exercise, the learner manages cardiac arrest secondary to unrecognized hemorrhage during spinal fusion surgery in a pediatric patient with neuromuscular scoliosis. Patient management is complicated by prone positioning. Simulation provides an opportunity for the learner to formulate a differential diagnosis, communicate and effectively implement a treatment plan, and mobilize additional resources during a crisis situation. Methods This resource includes an instructor guide addressing target audience, learning objectives, necessary equipment, case narrative, and a debriefing plan. A sample simulation program and a participant evaluation form are also provided. Results This work has been implemented on four anesthesiology residents in clinical anesthesia year two and above. Overall, the simulation scenario has been well received by learners. Participants commented that they enjoyed not only the challenge of performing cardiopulmonary resuscitation in a prone patient, but they also liked being able to practice resuscitation algorithms that were not as familiar to them. Learners have found that the drug doses they thought would be appropriate for the simulated patient based on adult resuscitation algorithms were in fact not correct according to pediatric guidelines. Discussion Depending on your hospital's requirements, trainees participating in this exercise may not have completed Pediatric Advanced Life Support (PALS) certification through the American Heart Association. We recommend having copies of PALS algorithms available as cognitive aids to learners. The confederate acting as circulating nurse may cue the learner to access these cognitive aids should the learner express unfamiliarity with PALS algorithms. Learners are also slow to identify the need to return the patient to the supine position during chest compressions. The circulating nurse may need to prompt the learner to do so.

Keywords

• Cardiopulmonary Resuscitation
• Hemorrhage
• Patient Simulation
• Pediatrics