The impact of exposure to liver transplantation anesthesia on the ability to treat intraoperative hyperkalemia: A simulation experience

The objective of this study was to assess whether resident exposure to liver transplantation anesthesia results in improved patient care during a simulated critical care scenario. Our hypothesis was that anesthesia residents exposed to liver transplantation anesthesia care would be able to identify and treat a simulated hyperkalemic crisis after reperfusion more appropriately than residents who have not been involved in liver transplantation anesthesia care. Participation in liver transplantation anesthesia is not a mandatory component of the curriculum of anesthesiology training programs in the United States. It is unclear whether exposure to liver transplantation anesthesia is beneficial for skill set development. A high-fidelity human patient simulation scenario was developed. Times for administration of epinephrine, calcium chloride, and secondary hyperkalemia treatment were recorded. A total of 25 residents with similar training levels participated: 13 residents had previous liver transplantation experience (OLT), whereas 12 residents had not been previously exposed to liver transplantations (non-OLT). The OLT group performed better in recognizing and treating the hyperkalemic crisis than the non-OLT group. Pharmacologic therapy for hyperkalemia was given earlier (OLT 53.3 ± 27.0 seconds versus non-OLT 148 ± 104.1 seconds; P < 0.01) and hemodynamics restored quicker (OLT 87.9 ± 24.9 seconds versus non-OLT 219.9 ± 87.1 seconds; P < 0.01). Simulation-based assessment of clinical skills is a useful tool for evaluating anesthesia resident performance during an intraoperative crisis situation related to liver transplantations. Previous liver transplantation experience improves the anesthesia resident's ability to recognize and treat hyperkalemic cardiac arrest.