• Athanasios Tsiouris, Adam N Protos, Victoria D Keys, Deanna Chambers, Ashok Kumar Coimbatore Jeyakumar, and Jay G Shake.
• Athanasios Tsiouris is an assistant professor of cardiac surgery at the University of Mississippi Medical Center, Department of Surgery, Division of Cardiac Surgery, Jackson, Mississippi.
• Crit Care Nurse. 2024 Jun 1; 44 (3): 121812-18.

BackgroundEmergency resternotomy in the intensive care unit for a patient who has undergone cardiac surgery can be daunting for surgeons and critical care staff. Clinicians involved are often unfamiliar with the surgical instruments and techniques needed.Local ProblemAfter an emergency intensive care unit resternotomy resulted in suboptimal performance and outcome, protocols for emergency resternotomy were established and improved.MethodsEducation and simulation training were used to improve staff comfort and familiarity with the needed techniques and supplies. The training intervention included simulations to provide hands-on experience, improve staff familiarity with resternotomy trays, and streamline emergency sternotomy protocols. Preintervention and postintervention surveys were used to assess participants' familiarity with the implemented plans and algorithms.ResultsAll 44 participants (100%) completed the preintervention survey, and 41 of 44 participants (93%) returned the postintervention survey. After the intervention, 95% of respondents agreed that they were prepared to be members of the team for an emergency intensive care unit sternotomy, compared with 52% of respondents before the intervention. After the intervention, 95% of respondents strongly agreed or agreed that they could identify patients who might need emergency sternotomy, compared with 50% before the intervention. The results also showed improvement in staff members' understanding of team roles, activation and use of the emergency sternotomy protocol, and differences between guidelines for resuscitating patients who experience cardiac arrest after cardiac surgery and the post-cardiac arrest Advanced Cardiovascular Life Support protocol.ConclusionResults of this quality improvement project suggest that simulation training improves staff comfort with and understanding of emergency resternotomy.©2024 American Association of Critical-Care Nurses.

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