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Centre of excellence for new post-heart surgery resuscitation training

Waikato Hospital Critical Care nurse educators Mark Reynolds and Jackie

Photo: Waikato Hospital Critical Care nurse educators Mark Reynolds and Jackie Mailer

Waikato Hospital is leading out New Zealand training in a totally new approach to post-heart surgery resuscitation.

Cardiac Surgery Advanced Life Support training – or CALS for short – is an internationally endorsed training course involving simulation that allows surgical teams to practise and efficiently respond to cardiac arrest following heart surgery. The course focuses on optimizing team work and uses a sophisticated manikin designed to imitate the upper half of a patient’s body post-heart surgery including the internal structures covered by the sternum and held together with sternal wires.

Waikato District Health Board is the first place in New Zealand to provide CALS. “We are working closely with teams in Melbourne, Sydney, Adelaide, Perth, Europe and the USA to develop and deliver this essential healthcare,” says cardiothoracic surgeon and CALS NZ course director Mr David McCormack. “As a result of our expertise and training resources, we have been awarded the international Centre of Excellence status and can share it with other hospitals in New Zealand.”

McCormack is a recent consultant addition to the Waikato Cardiothoracic Surgery team. He has worked at all of the major hospitals in London and previously served on the National Executive for Cardiothoracic Surgery in Great Britain and Ireland. He directed many CALS courses in the UK where the resusitation approach was initially developed. Since then it has spread to most parts of Europe and USA, and now it is the turn of Australasia.

Thousands of open heart operations are performed annually in Australasia. The vast majority of patients recover fully and go home within a week, but a small percentage experience cardiac arrest after surgery. When this happens, efficient team work is essential to save the patient in a time-critical situation. CALS enables the identification of cause and the correct response to happen in less than five minutes, with a focus on quickly providing specialist treatment including, when appropriate, re-opening a person’s chest ready for surgical intervention. This treatment is more effective than relying on continued isolated chest compressions. Effective team work and communication are crucial. Critical care staff, theatre staff, heart surgeons, intensive care (ICU) doctors, anaesthetists and cardiac ward nurses must all work “in synch” to and get the best outcome for the patient.

Waikato Hospital’s Cardiothoracic department in one of the busiest in Australasia and performs over 600 open heart surgeries each year.

As well as the internationally endorsed CALS NZ courses being held at Waikato Hospital, regular in-house CAL training sessions have been developed by Waikato Hospital Critical Care nurse educators Mark Reynolds and Jackie Mailer. A briefing on the CALS algorithm (including decision making steps and key positions) soon moves to realistic “hands-on” training, first done in slow motion as staff learn what to do, then in real-time, aiming for less than five minutes from cardiac arrest to being ready for the surgeon to re-open the patient.

Reynolds says a bonus from introducing the initiative is that it has brought different staff groups closer together.

The international CALS director, Adrian Levine, has been impressed by our innovative Waikato team and has referred numerous European units to us to enhance their practice.

David McCormack pays tribute to the leadership of clinical director of Cardiothoracic services Professor Adam El Gamel, the ICU cardiac lead Pranesh Jogia and the expertise of Rob Sinclair, director Clinical Skills and Simulation Centre who provides a high fidelity and realistic simulation environment.

“The cardiothoracic team at Waikato Hospital is amongst the best I’ve ever worked in and the Clinical Training and Simulation Centre at the hospital is world leading,” he says.

The CALS NZ course director is also full of praise for the Critical Care nurse educators – “Mark and Jackie are top notch. They have taken a well-established international course and made it even better. Their coordination, resourcefulness and educational talent are massively impressive.”

To date Waikato DHB has run 10 internal courses and three national courses, including training staff from most of the cardiac surgery units in New Zealand.

For more information visit www.csu-als.com/cals-anz

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