ABSTRACT
IntroductionThe need to provide ‘clean, non-COVID’ surgical areas during the current pandemic has mandated many changes within our organisation, such as the redeployment of cardiac surgical services (albeit without the transfer of interventional cardiology) to a different hospital within our health board. This move necessitated the upskilling of general anaesthetists to provide anaesthesia for emergency procedures in the cardiac catheterisation suite (cath-lab). This is an unfamiliar remote environment which may challenge anaesthetic teams, as they face limited access to the patient, radiation hazards and lack of familiarity with these procedures. As a result, an immediate training response was required to ensure patient safety.MethodsWe conducted a survey to assess baseline staff experiences and opinions. Following this we created a workgroup to develop specific anaesthesia guidelines, which were provided to candidates. A simulation course was developed, including scenarios designed to familiarise anaesthetists with common cath-lab emergencies and challenges and their potential solutions. Anaesthetists completed surveys before and after their simulation training. Notably, these courses were conducted during the COVID outbreak, hence adhering to social distance and infection control procedures.ResultsOur surveys highlighted that anaesthetists found the cath-lab a stressful environment, and all felt that multiprofessional teamwork could be improved. 25 individuals completed the simulation training. We measured self-assessed anxiety to the prospect of dealing with an unexpected emergency in the cath lab, both pre and post training, on a Likert scale (0 to 10). This decreased from an average of 7.55 to 5.63. All candidates commented that they found the course useful and advocated for further in situ training. Remarkably, the course provided a number of unexpected clinical safety outcomes: It facilitated interdisciplinary conversations and further team training was agreed upon;infection control measures for aerosol generating procedures were revisited in collaboration with anaesthetists, and the need for a consistent anaesthetic link was identified.DiscussionOur results demonstrated that anaesthetists felt safer and better prepared to manage emergencies or unstable patients in the cardiac catheterisation laboratory. Post course reflection identified a need to expand scenarios to include cardiac arrest within the cath lab. Further training will be carried out wearing FFP3 masks and visors in order to increase fidelity and help prepare the team to communicate in this manner. We look forward to continuing exploring non-technical skill challenges during forthcoming multiprofessional training sessions.