Emergent Bedside Re-sternotomy: An Innovative Simulation Model for Training Pediatric Cardiac Intensive Care Teams

Authors

• Toluwani Akinpelu, The University of Texas Rio Grande ValleyFollow
• Nikhil R. Shah, University of Texas Medical Branch
• Mohammed Alhendy, The Children's Hospital of San Antonio
• Malarvizhi Thangavelu, The Children's Hospital of San Antonio
• Karen Weaver, The Children's Hospital of San Antonio
• Nicole Muller, The Children's Hospital of San Antonio
• James McElroy, The Children's Hospital of San Antonio
• Utpal Bhalala, Driscoll Children's Hospital

Document Type

Article

Publication Date

11-30-2025

Abstract

Introduction: Cardiac tamponade after cardiac surgery is a life-threatening event that requires simultaneous resuscitation and emergent re-sternotomy by the intensive care team. A simulated scenario using an innovative mannequin with sternotomy wound has the capability of reproducing cardiac arrest associated with postoperative tamponade. We evaluated the validity of this mannequin to investigate the confidence level and crisis resource management skills of the team during bedside re-sternotomy to manage postoperative cardiac tamponade.

Methods: The simulation scenario was developed using the sternotomy mannequin for a pediatric cardiac intensive care unit (CICU) team. The case involved a 3-year-old male, intubated, mechanically ventilated after surgical repair of congenital heart disease, progressing to cardiac arrest due to cardiac tamponade. We conducted a formative learner assessment before and after each scenario as well as a structured, video debriefing following each encounter. The simulation was repeated in a 6-month interval to assess knowledge retention and improvement in clinical workflow. The data was analyzed using student t-test and chi-square test, when appropriate.

Results: Of the 72 CICU providers, a significant proportion of providers (p < 0.0001) showed improved confidence in assessing and managing cardiac arrest associated with postoperative cardiac tamponade. All providers scored ≥ 3 for impact of the scenario on practice, teamwork, communication, assessment skills, improvement in cardiopulmonary resuscitation and opening the chest and their confidence in attending similar clinical situations in future. Most (96–100%) scored ≥ 3 for perception on realism of mannequin, the scenario, re-opening the sternotomy and level of stress. Time to diagnosis of cardiac tamponade (p=.004), time to first dose of epinephrine (p=0.045), and median number of interruptions to chest compressions (p=0.006) all significantly decreased between the two sessions. Time to completion of re-sternotomy improved by 81.4 seconds, however, this decrease was not statistically significant.

Conclusions: Implementation of a high-fidelity mannequin for postoperative cardiac tamponade simulation can achieve a realistic and reproducible training model with positive impacts on multi-disciplinary team education.

Comments

This article is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License (CC BY-NC 4.0)

Recommended Citation

Akinpelu, T., Shah, N. R., Alhendy, M., Thangavelu, M., Weaver, K., Muller, N., McElroy, J., & Bhalala, U. S. (2025). Emergent bedside re-sternotomy: An innovative simulation model for training pediatric cardiac intensive care teams. Journal of Pediatric Intensive Care, 14(5), 366-375. https://doi.org/10.53391/2146-4618.1055

Creative Commons License

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License

Publication Title

Journal of Pediatric Intensive Care

DOI

10.53391/2146-4618.1055

Academic Level

medical student

Mentor/PI Department

Pediatrics