Cognitive Aids in a Simulated Anesthetic Crisis

Abstract

To the Editor: We congratulate Harrison et al. (1) on their efforts to advance the knowledge of the use of cognitive aids during anesthesia crises. As they identified, accessible checklists, protocols, and standard operating procedures are not used at the point of delivery of anesthesia care as frequently as in other high-risk industries such as aviation and nuclear power. In this particular example, the knowledge required by a team to perform the multitude of diverse tasks in such a rare and high risk situation as malignant hyperthermia is immense. Translating this knowledge into effective team activity requires the optimal use of all available resources including appropriate distribution of tasks within the team. On the basis of our own observations of the management of simulated malignant hyperthermia scenarios at our simulation center, we developed a series of cards 6 years ago to aid in distributed cognition during a malignant hyperthermia crisis, in accordance with Australian and New Zealand College of Anesthetists guidelines (2). These color-coded laminated cards are kept in a visible pocket on the malignant hyperthermia cart. The team leader distributes the cards to the members of the team. Each card defines the tasks to be performed by a series of subteams, thus allowing parallel processing of all the required tasks. We believe the cards also allow redundancy through mutual performance monitoring, and reduce the risk of errors of omission. Although we have not formally tested the effect of these cards on team performance, we have had valuable positive feedback from simulation center participants and reports of use in actual crises. Stuart Marshall, FANZCA Brendan Flanagan, FANZCA Southern Health Simulation and Skills Centre Melbourne, Australia [email protected]