Session Delves Into Strategies for Cardiac Surgical Emergencies



2:30 p.m. – 4:30 p.m.

Room 360A

Ensuring optimal patient safety and outcomes during cardiac surgical emergencies requires a multidisciplinary team-based approach. A special Sunday session will examine strategies for team members as they respond to these emergencies, in particular acute aortic dissection, initiation of extracorporeal membrane oxygenation (ECMO), and decompensation related to transcatheter aortic valve replacement (TAVR).

“There has been a renewed interest in the contributions we all make to ensure we recognize these situations. We no longer are seeing the ‘captain of the ship’ mentality as being effective,” said co-moderator Jill Ley, RN, MS, of California Pacific Medical Center in San Francisco. “We all are thinking about teamwork, communication, and how to break down barriers, so that we’re all practicing as efficiently as we possibly can. This means assuring that the right members of the team are talking about how they can communicate effectively and bring everyone to the table as quickly as possible to manage these emergencies.”

Jill Ley, RN, MS

Jill Ley, RN, MS

Presenters will share the hallmark features that signal the need for emergent intervention, provide evidence-based approaches, and discuss strategies for communication and collaboration during management of acute surgical emergencies.

“The common theme we’ll discuss is how we position ourselves to train for the recognition and management of these acute emergencies,” Ley said.

When patients in the ICU present with acute aortic dissections, a host of medical professions are called upon to act quickly, said Walter H. Merrill, MD, of Vanderbilt University School of Medicine in Nashville. Dr. Merrill is Chair of the STS Workforce on Associate Membership, which planned the session.

Walter H. Merrill, MD

Walter H. Merrill, MD

“This is not an elective procedure. It’s urgent and somewhat dangerous,” Dr. Merrill said. “A patient might be stable when he or she presents in the emergency room but quickly could become unstable and die because of cardiac tamponade. It’s important to focus on the teamwork involved. Proper evaluation, diagnosis, and getting the patient through the operation and recovery is key.”

The same set of processes is vital for patients who experience cardiopulmonary compromise and warrant ECMO. Dr. Merrill noted that in the last 10 years, the use of ECMO has gone from being available at a few specialized centers to being performed at most hospitals.

“Putting a patient on ECMO doesn’t happen without a lot of planning. We want to look at best practices and raise everyone’s consciousness so they understand how to care for these patients,” Dr. Merrill said.

Although TAVR procedures are becoming more common, patients may develop heart failure due to acute aortic regurgitation and require intubation.

“Sometimes, a TAVR procedure must be converted to a surgical aortic valve replacement,” Dr. Merrill said. “One has to be prepared for everything. It’s not always simple and straightforward.”

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