Performance of anesthesia residents during a simulated prone ventricular fibrillation arrest in an anesthetized pediatric patient

Background: Exposure to rare pediatric anesthesia emergencies varies depending on the residency program. Simulation can provide increased exposure to these rare events, improve performance of residents, and also aid in standardizing the curriculum. Objective: The purpose of this study was to evaluate time to recognize and treat ventricular fibrillation in a pediatric prone patient and to expose learners to the difficulties of managing emergencies in prone patients. Methods: Standardized simulation sessions were conducted monthly for 13 months with groups of 1-2 residents in each simulation. The scenario involved a prone patient undergoing posterior spinal fusion. Ventricular fibrillation occurred three minutes into the case. Sessions were viewed by simulation staff, and time to events was recorded. A scripted debriefing followed each case. Evaluations were completed by each participant. Results: The average time to start chest compressions was 77 s, and the average time in recognizing ventricular fibrillation was 76 s. No group performed chest compressions while prone. Only one group defibrillated in the prone position. Participants average time to request defibrillation was 108 s. While nine of 13 groups (69%) ordered an arterial blood gas, only five recognized hyperkalemia, and only four groups gave calcium. Conclusions: Anesthesia residents need additional training in recognizing and treating operative ventricular fibrillation, especially in prone patients and rarely encountered etiologies such as hyperkalemia. Training in the treatment of uncommon pediatric emergencies should be a focal point in anesthesia residency programs.