Procedural Alert for cardiac arrest in OR to be implemented in May


Submitted by Robert Day MD, Chair, Main Line Health Anesthesia Department


Cardiac arrest during surgery is a rare but difficult event.  The Anesthesia Quality Institute, which is in charge of collecting anesthesia quality data in the United States, recently published an article stating the rate of cardiac arrest during surgery is 5.6 per 10,000 cases, and the mortality in those cases is 58.4%.  The implication for the individual practitioner is that he or she may only encounter such a case once every 2-3 years, but for a large institution there may be several events expected each year.  One of the challenges this poses is how to be able to handle these critical events in an organized fashion.


In response to several of these events, the Main Line Health Quality and Safety Committee tasked the Anesthesia, HMS, and Nursing departments to develop such an approach, and we are calling it “Procedural Alert.”  Representatives from each department met together to define the scope, the necessary tasks and the required personnel, the methods of communication, and practical matters such as how people are directed to the OR, and location of masks and gowns. The new process will be implemented in May.


There were several key issues that were identified.  One is the need for a designated code leader.  It will be the anesthesiologist unless that person is busy and cannot pay full attention to the code itself, in which case the HMS physician will lead the code.  The code leader does not touch the patient but has full attention on running the code.  Another issue was delineating the necessary jobs, such as getting the code cart, doing chest compressions, hanging drips, etc., and who would be best to do each one of these jobs.  Walk-through drills were performed on each procedural unit in each hospital, and the available personnel were slightly different in each hospital and in the different units in the same hospital.  Another issue was the concept of using checklists during critical events, and we have taken the checklist developed at Massachusetts General Hospital and made copies, which will be attached to every anesthesia cart.  Finally, the need for periodic drills was identified.  Drills are being conducted now on each campus in preparation for rolling out the new process. The drills are being performed using a simulated patient, or Sim Man, which is run by HMS using scenarios developed by an anesthesiologist.


The drills are being scheduled in each procedural area for each hospital, so that includes the operating suite, outpatient surgery suite, endoscopy and C-section rooms.  They will be performed on a regular basis, as are fire drills and malignant hyperthermia drills.  Again, the goal of these drills is to ingrain a practiced approach to critical events in the procedural areas, and so improve the outcome of such events and thus improve safety for our patients who undergo procedures at Main Line Health.


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