Simulation-based training of critical events during cardiopulmonary bypass: importance of a critical events checklist.

OBJECTIVES: Evaluation of critical events training for clinical perfusionists is necessary to improve this educational approach. Critical events checklists are effective in reducing clinical complications, but should be tested in a simulation environment first. Individual behavior and stress response of clinical perfusionists during simulated critical events on cardiopulmonary bypass have not been evaluated yet. This study focuses on the evaluation of critical events training and critical events checklists in simulated cardiopulmonary bypass. METHODS: A total of 19 clinical perfusionists from a single hospital took part in two simulated critical event scenarios. Clinical perfusionist behavior and physiological responses were recorded using eye tracking, heart rate variability, video, and audio. In addition, workloads were determined and participants were interviewed. RESULTS: Relevant areas of interest were identified for each simulation phase. During critical event detection and subsequent decision-making, areas of interest hits and fixation durations varied with the use of a critical events checklist. Times to decision were shorter, decision quality was higher, and temporal workload was increased when the checklist was used. Evaluation of selected heart rate variability measures revealed a good correlation with pupil diameters. CONCLUSION: Evaluation of critical events during simulated cardiopulmonary bypass shows that the scenario is realistic and relevant for clinical practice. Integrating a critical events checklist improves the probability of correct decision-making and shortens the correct decision time. Temporal workload is increased when using a checklist. Eye tracking and heart rate variability are well suited to evaluate participants' behaviors and stress levels. All participants welcomed simulation training for critical incidents.

Additional veno-venous gas exchange as a problem-solving strategy for an oxygenator not transferring oxygen in paediatric cardiopulmonary bypass.

OBJECTIVES: Oxygenator failure during cardiopulmonary bypass constitutes a life-threatening event, especially when perfusion is conducted under normothermia. An alternative solution to emergency oxygenator changeover is described. METHODS: A supplementary oxygenator is added in the venous line without interrupting perfusion. De-airing is achieved through the cardiotomy reservoir. Oxygen supply is adapted to ensure physiologic partial oxygen pressure. RESULTS: On 5 occasions in the past 4 years, Capiox Baby FX 05 oxygenator (n = 4) and Capiox FX15 (n = 1) failed to exchange blood gases after bypass run ranging from 290 min to 563 min. Hypoxia ensued with partial oxygen pressure values of 49-79 mmHg with a fraction of inspired oxygen of 1. An additional veno-venous Terumo Capiox FX 05 oxygenator immediately improved oxygenation with resulting partial oxygen pressure increasing to at least 291 mmHg. CONCLUSIONS: An additional veno-venous oxygenator effectively corrects failing oxygenator during cardiopulmonary bypass. The method does not require circulation arrest. It does not carry the risk of air embolism. It can be carried out without any help from a second perfusionist or member of operation team.