Simulation-Based Training for the Anesthetic Management of Patients With Left Ventricular Assist Devices Undergoing Gastrointestinal Endoscopy
Katherine H. Hatter, Amanda L. Faulkner, Paris Rizzo-Thompson, Cooper Pitts, Jennifer Hajj, Dulaney A. Wilson, Haley Nitchie, Stephanie K. Whitener, Catherine D. TobinIntroduction
Improved survival among left ventricular assist device (LVAD) patients has increased the need for non-cardiac procedures. Given that gastrointestinal bleeding remains a major adverse event in LVAD patients, colonoscopies and endoscopies encompass many of the non-cardiac procedures performed in this population. Limited formal training on anesthetic management of LVAD patients can reduce provider confidence and preparedness. A prospective educational intervention study was developed in the form of a structured, simulation-based educational course, created to enhance expertise and improve provider confidence.
Methods
The designed program combines an online module and four in-person simulation scenarios focused on anesthesia for endoscopy cases in LVAD patients, followed by evaluation of changes in knowledge, confidence, and simulation performance. Participants completed a pre-training knowledge test and a confidence survey prior to any intervention. Participants then completed pre-course training modules and performed Simulation 1, followed by a post-training knowledge test, and a confidence survey. They returned 4-8 months later for a knowledge retention test and confidence survey followed immediately by Simulation 2. Pre- and post-training scores were compared using t-tests for the total cohort and novice/experienced subgroups.
Results
44 participants enrolled; 41 completed all assessments. Passing rates of scenarios 1-4 increased from 48.8%, 82.9%, 36.6% and 48.8% to 97.6%, 100%, 80.05%, and 65.9% respectively between their initial and second attempt. Knowledge scores significantly improved after completion of Simulation 1 (p <0.001) but were not significantly different from post-Simulation 1 scores at Simulation 2 (p =0.60). Confidence scores increased from 2.0 ± 0.6 to 3.7 ± 0.6 after Simulation 1 (p <0.001). Confidence declined slightly before Simulation 2 (p <0.02) but remained higher than pre-Simulation 1 (p <0.001).
Discussion
Simulation-based education significantly improved anesthesia providers’ knowledge and confidence in managing LVAD patients. While some skill decay occurred over time, confidence and knowledge remained higher than baseline. This approach demonstrates promise for broader applications in anesthesia training.