ABSTRACT #50

A NOVEL SIMULATION BASED EDUCATIONAL CURRICULUM TO IMPROVE INTERNAL MEDICINE RESIDENT MANAGEMENT OF POST-CARDIAC SURGERY PATIENTS FOLLOWING CARDIAC ARREST

Elizabeth Zipf, Susannah Kurtz, Priscilla Loanzon, Barbara Sierra, Harrindra Seepersaud, James Salonia

PURPOSE AND GOALS: The incidence of cardiac arrest following adult cardiac surgery is 0.7 - 8%, and the survival rate remains remarkably high (79%). This impressive survival rate has been partly attributed to a high incidence of reversible causes of cardiac arrests in this population. The Society of Thoracic Surgery (STS) expert consensus has published a protocol to address these reversible causes, which deviates from the American Heart Association’s ACLS algorithm. Although the protocol has become the standard of care for managing cardiac arrests in post-cardiac surgery patients, it is not traditionally included in internal medicine (IM) residency training. Mount Sinai Morningside is a center for cardiac surgery where IM residents are first responders to in-hospital cardiac arrests and may resuscitate post-cardiac surgery patients. The goal of this project was to evaluate and improve residents’ knowledge and comfort in managing cardiac arrest in this specific patient population.

METHODS: A high-fidelity simulation case was developed to address the resuscitation of patients who arrest after cardiac surgery based on the STS protocol. Pre and post-simulation surveys were developed to evaluate residents’ knowledge and comfort in managing this population. The surveys and simulation case were approved by the Center for Advanced Medical Simulation team.

EVALUATION PLAN: The case was integrated into PGY2 and PGY3 IM resident ACLS Simulation Sessions from 7/2022 - 9/2022. A chi-squared test was utilized to analyze improvement in residents comfort level in resuscitating post-cardiac surgery patients and ability to identify a difference in resuscitation of this population. A paired sample t-test and Mann- Whitney U test were utilized to analyze differences in knowledge between pre and post-simulation surveys.

SUMMARY OF RESULTS: A total of 75 IM residents participated in the simulation. 88% of residents reported they never received training in resuscitating a post-cardiac surgery patient and 4% felt comfortable resuscitating this population. Compared to the pre-simulation survey, there was a 29% improvement in recognizing differences in cardiac resuscitation between post-cardiac surgery patients and standard ACLS (p<0.001); a 63% improvement in comfort resuscitating this population (p<0.001); and a significant improvement in knowledge of the protocol (pre-simulation mean 2.27 [1.1], median [1,3]; post-simulation mean 3.8[1], median 4[3,4], p<0.001).

REFLECTIVE CRITIQUE: This simulation training session resulted in a statistically significant improvement in residents’ ability to recognize differences in managing a post-cardiac surgery cardiac arrest, comfort level in resuscitating this population, and knowledge regarding the STS protocol. It is important to note that this training was provided to senior residents who are often the code team leaders; however, PGY1 residents may often be the first responders to in- hospital cardiac arrests. Future work may include this training for PGY1 residents after they have received sufficient ACLS training.