Changing Patient Population Drives Critical Care Symposium

The definition of a “traditional” cardiothoracic surgery patient is evolving. As patients become older and more frail, the strategies to ensure good outcomes and handle issues that arise postoperatively are changing.

“Clinicians need to be up-to-date on the elements of care for these patients, who are more complex and have more comorbidities,” said moderator Rakesh C. Arora, MD, of the University of Manitoba and St. Boniface Hospital in Winnipeg, Canada.

STS/AATS Critical Care Symposium: When Things Go Wrong in the CTICU and What to Do About It

Sunday, January 28
8:00 a.m. – 12:00 p.m.
Floridian Ballroom D

This year’s STS/AATS Critical Care Symposium will help members of the entire cardiothoracic surgery team do just that. Categorized into three sessions, the topics discussed at the Symposium will cover how to make things go right, what to do when things go wrong, and handling end-of-life decisions.

“How to make things go right” includes good communication and using checklists, especially when patients transition to different members of the health care team.

Rakesh C. Arora, MD

Moderator Michael S. Firstenberg, MD, of Summa Akron City Hospital in Ohio, noted that checklists help to ensure that all clinicians involved in a patient’s care are on the same page about major issues. “This seems to be a painfully obvious way to reduce morbidity and mortality, but there has been some resistance, most likely because people are not sure how to implement the process,” he added.

The “when things go wrong” portion of the Symposium will emphasize both the practical and ethical aspects of managing challenging situations. “Clinicians tend to focus on the positive experiences, but we all know that there’s a certain reality where things don’t always go well,” Dr. Firstenberg said.

Failure to rescue has been strongly tied to variations in mortality, and studies suggest that systems-level interventions may improve the quality of care. “The literature in cardiothoracic surgery and other high-risk settings has shown that bad outcomes are rarely the result of one individual,” said Dr. Firstenberg. “How can we make sure things will go well? You need an integrated, predictable process. It’s this kind of process that gives you an orchestra, rather than just a group of musicians playing their instruments.”

Dr. Arora noted that another issue to consider, given the changing patient population, is long-term outcomes. “What happens when older patients leave the hospital and go home? Are they surviving? Or are they thriving?”

Advances in technology have been helpful in prolonging life, and high-cost innovations such as extracorporeal membrane oxygenation (ECMO) are being used with increasing frequency; however, the use of ECMO is controversial.

“We’ll explore the moral and ethical aspects, as well as fiscal responsibility, in futile situations,” said Dr. Firstenberg. Following that discussion, two cardiothoracic surgeons will square off in a debate about whether ECMO-assisted CPR should be included as part of every cardiopulmonary arrest protocol.

“It’s the first time we’ve included a debate in this Symposium, and we’ll present case examples and ask for audience participation,” said Dr. Arora. “I’m excited about this new addition because attendees will gain perspectives that they can implement with their multidisciplinary teams when they get home.”