Are anaesthetists adequately trained to resuscitate patients?

Abstract

EDITOR: Resuscitation is not performed on a regular basis by the vast majority of anaesthetists, especially those who no longer form part of a cardiac-arrest team. There is however a perception that anaesthesia is the lead specialty in this area [1]. There is no routine continued assessment of an anaesthetist's capability to perform cardiopulmonary resuscitation nor a specific requirement to maintain one's knowledge. We set out to survey both the level of training and knowledge of the universal algorithm (Resuscitation Council UK Guidelines, 1997) in one region of England to ascertain whether training within the region met recommended standards and whether knowledge was appropriate to clinical need. In all, 150 anaesthetists were surveyed from five different hospitals during April 2005. Of them, 49 (33%) had received no formal basic life support (BLS) or advanced life support (ALS) training within the last 3 yr, either internal (provided by the hospital) or external (formal course). Of those who were surveyed, 61 (41%) had completed a Resuscitation Council UK ALS course within the past 3 yr. The proportion of anaesthetists completing this course was less in those in non-training posts compared to those in training posts (Fig. 1)Figure 1.: The percentage of ALS and non-ALS providers for each grade of anaesthetists surveyed (NCCG: non-consultant career grade; SPR: specialist registrar; SHO: senior house officer (junior trainee)).Of the untrained (no training in the last 3 yr) anaesthetists, 82% knew the first shock energy and 88% knew the dose of epinephrine. For trained anaesthetists this was 87% for first shock and 91% for dose of epinephrine. Knowledge of the algorithm was poor in both the trained and untrained anaesthetists. It has been demonstrated that retention of knowledge after resuscitation training is poor, when re-evaluated over a 6-month period [2]. This emphasizes the need for periodic reinforcement, especially for those who do not attend cardiopulmonary arrests on a frequent basis. Of those who were on a cardiac arrest team, 94% knew the dose of epinephrine and 87% knew the first shock energy with a defibrillator. For those who were not on a cardiac arrest team, this was 83% for dose of epinephrine and 82% for first shock. This demonstrates that regular attendance at cardiac arrests preserves knowledge. The findings of this survey are similar to previous work. Bell and colleagues [3] assessed the basic and advanced cardiopulmonary resuscitation skills of 30 trainee anaesthetists, and found that the management of ventricular fibrillation and asystole was carried out correctly by only 27% and 30% of anaesthetists, respectively. The conclusion from this study was that all trainee anaesthetists needed to undergo regular training and assessment of their resuscitation skills. Despite a level of training below recommended standards, 90% of anaesthetists felt they were able to run a cardiac arrest. This feeling seems to be contrary to their overall knowledge of the algorithm. Most anaesthetists work in clinical isolation and in the event of an on-table cardiac arrest would be expected to initially resuscitate the patient. It is important therefore that all grades of anaesthetists are trained appropriately. Knowledge of ALS and BLS forms an important clinical governance issue for all anaesthetists. It is however the responsibility not only of the individual but also of the relevant hospitals or departments of anaesthesia to ensure that an adequate training structure is provided for all anaesthetists. This is of particular importance when guidelines change, as was the case in 2005. R. J. Green J. Bromilow D. Richardson C. D. Deakin *Shackleton Department of Anaesthetics, Southampton University Hospital NHS Trust, Southampton, UK