Simulation Sessions Help ICU Clinicians Prepare for High-Risk, Infrequent Emergency Procedures

Simulation sessions can help maintain clinician proficiency and prepare staff members to be part of the multidisciplinary team during high-risk procedures that happen suddenly and infrequently.

One such situation is an emergency resternotomy in the intensive care unit (ICU) for patients recovering from cardiac surgery who experience cardiac arrest. The surgery involves reopening the patient’s chest after defibrillation did not resuscitate them. It is performed in the ICU, without transferring the patient to an operating room, and can be challenging for all clinicians involved as they race to save the patient.

The cardiovascular ICU at University of Mississippi Medical Center, Jackson, developed a three-part program to improve clinicians’ ability to recognize clinical signs that would prompt an urgent sternotomy for a postoperative cardiac surgery patient and to clarify individual roles during the emergency procedure.

Simulation Training for Emergency Sternotomy in the Cardiovascular Intensive Care Unit” details the program and its impact based on results of preintervention and postintervention surveys. The study is published in Critical Care Nurse (CCN).

Co-author Athanasios Tsiouris is an assistant professor of cardiac surgery at the medical center.

“These events are fortunately rare, but when they do occur, staff members need to be familiar with the surgical instruments and techniques needed,” Tsiouris said. “Ongoing education and simulation training allow them to rehearse these situations as a team and have hands-on experience prior to a real-life patient emergency.” 

The program began with one-hour didactic education sessions that included guidelines from the Society of Thoracic Surgeons for this patient population, clarification of team roles, and logistics such as the contents and location of emergency carts and surgical packs.

The second phase focused on procedures to improve nurse-surgeon communication and increase the speed of establishing a sterile field and wire removal. Equipment and supplies were reviewed, and naming conventions and surgeons’ preferences for procedural details were standardized.

The final phase placed the participants in various simulated scenarios with postoperative cardiac surgery patients who may need emergency resternotomy.

After the sessions, 95% of the 41 individuals who completed both surveys agreed that they were prepared to be part of the team for the emergency ICU sternotomy, compared with 52% of respondents before the sessions. In addition, 95% strongly agreed or agreed that they could identify patients who might need an emergency sternotomy, compared with 50% prior to the intervention.

The results also showed improvement in staff members’ understanding of team roles and activation and use of the emergency sternotomy protocol. Participants also indicated understanding the differences between guidelines for resuscitating patients who experience cardiac arrest after cardiac surgery and the more commonly used Advanced Cardiovascular Life Support protocol.

In addition, the simulations helped proactively identify equipment or systems issues that may arise during a real-life situation, leading to quality improvement in the ICU and streamlining of established protocols.

Members of the ICU nursing staff now participate in the didactic and simulation sessions twice a year to ensure that those new to the unit have taken them and that everyone is prepared for the next time a patient requires this emergency surgery.

As the American Association of Critical-Care Nurses’ bimonthly clinical practice journal for acute and critical care nurses, CCN is a trusted source of information related to the bedside care of critically and acutely ill patients. Access the article abstract and full-text PDF by visiting the CCN website at

About Critical Care Nurse: Critical Care Nurse (CCN), a bimonthly clinical practice journal published by the American Association of Critical-Care Nurses, provides current, relevant and useful information about the bedside care of critically and acutely ill patients. The award-winning journal also offers columns on traditional and emerging issues across the spectrum of critical care, keeping critical care nurses informed on topics that affect their practice in acute, progressive and critical care settings. CCN enjoys a circulation of about 130,000 and can be accessed at

About the American Association of Critical-Care Nurses: For more than 50 years, the American Association of Critical-Care Nurses (AACN) has been dedicated to acute and critical care nursing excellence. The organization’s vision is to create a healthcare system driven by the needs of patients and their families in which acute and critical care nurses make their optimal contribution. AACN is the world’s largest specialty nursing organization, with about 130,000 members and nearly 200 chapters in the United States.

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