Optimizing Patient Access During an Emergency While Using Intraoperative Computed Tomography. World Neurosurg 2019 Jan;121:274-278.e1
Date
09/30/2018Pubmed ID
30266700DOI
10.1016/j.wneu.2018.09.134Scopus ID
2-s2.0-85055257185 (requires institutional sign-in at Scopus site) 4 CitationsAbstract
BACKGROUND: As minimally invasive spine surgery evolves, spine surgeons increasingly rely on advanced intraoperative computed tomography (iCT). iCT provides rapid acquisition of high-resolution images, reduces radiation exposure, improves surgical accuracy, and decreases operative time. However, all iCT systems currently available pose a patient safety risk as their physical space requirements limit patient access in the event of an emergency, particularly when patients are in the prone position. After a near-cardiac arrest at our institution during posterior cervical spine surgery, it was apparent that the presence of the iCT complicated the ability to rapidly reposition the patient in order to provide appropriate resuscitation.
METHODS: To ensure our ability to provide timely care during an emergency, we determined that a process which included all members of the operating room (OR) team was required. We held an initial planning meeting where a detailed plan-of-action was created, reviewed, and revised in response to feedback from all stakeholders. We then simulated a cardiac arrest to test our resuscitation plan with all members of the neurosurgery team. A mannequin was positioned prone on an OR table within the iCT, and a resuscitation plan was created.
RESULTS: The team orchestrated the mock resuscitation, and the time of cardiac arrest in the prone position to supine repositioning required 110 seconds. The simulation was recorded for post-"code" performance review. Application of the protocol during an actual cardiac arrest was associated with successful restoration of spontaneous circulation and full recovery.
CONCLUSIONS: The development and rehearsal of an emergency plan of action greatly facilitated the timely responsiveness of the neurosurgical OR team during a simulated cardiac arrest and was an effective way to identify and address key logistical issues regarding the use of an iCT system.
Author List
Bustillo MA, Lien CA, Mack PF, Kopman DJ, Safavynia SA, Rubin L, Stein D, Hartl R, Stieg PE, Hernandez RN, Goldstein PAAuthor
Cynthia A. Lien MD Chair, Professor in the Anesthesiology department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
AgedCervical Vertebrae
Clinical Protocols
Emergency Medical Services
Emergency Treatment
Heart Arrest
Humans
Male
Neurosurgical Procedures
Operating Rooms
Patient Positioning
Surgery, Computer-Assisted
Time Factors
Tomography, X-Ray Computed
