Con: cardiac anesthesiologists should not be the intensivists of the operating room.

Abstract

Listen

Translate article

ANESTHESIOLOGISTS can be challenged when caring for patients who are critically ill before surgery and by those who develop critical illness during a surgical procedure. The care of critically ill patients can be fundamentally different from the routine care rendered in the operating room. In the setting of a major intraoperative crisis such as cardiac arrest, massive unexpected hemorrhage, or hypoxemia refractory to aggressive therapies, the skill set of the operating room team can be pushed to the limit. Operating room crises require rapid, coordinated management in a stressful, time-critical setting, and successful resuscitation depends largely on clinicians’ retained knowledge and skill. Failure to adhere to critical steps in the management of such crises is common and may be hazardous to patients. A high-fidelity simulation study of ventricular fibrillation cardiac arrests in the operating room revealed that 61% of anesthesiologists demonstrated “major deviations” from advanced cardiac life support protocols. 1 The availability of specialized teams and resources for support during management of crisis situations is essential and is the focus of ongoing investigations. 2,3 Physicians with expertise in the care of critically ill patients and who regularly manage acute crisis situations must be available to provide consultation in the operating room when the need arises. With formal training and daily experience in managing critically ill patients, the fellowship-trained critical care anesthesiologist is the obvious choice to fulfill this role. Unfortunately, the specialty of critical care medicine is facing a staffing crisis. 4–6 The growing shortage of intensivists and its implications for hospitalized Americans is well documented and remains an ongoing concern for hospitals, clinicians, and the federal government. 6 The mismatch between intensivist