Vinod Havalad

Temporary biventricular pacing decreases the vasoactive-inotropic score after cardiac surgery: A substudy of a randomized clinical trial

OBJECTIVE Vasoactive medications improve hemodynamics after cardiac surgery but are associated with high metabolic and arrhythmic burdens. The vasoactive-inotropic score was developed to quantify vasoactive and inotropic support after cardiac surgery in pediatric patients but may be useful in adults as well. Accordingly, we examined the time course of this score in a substudy of the Biventricular Pacing After Cardiac Surgery trial. We hypothesized that the score would be lower in patients randomized to biventricular pacing. METHODS Fifty patients selected for increased risk of left ventricular dysfunction after cardiac surgery and randomized to temporary biventricular pacing or standard of care (no pacing) after cardiopulmonary bypass were studied in a clinical trial between April 2007 and June 2011. Vasoactive agents were assessed after cardiopulmonary bypass, after sternal closure, and 0 to 7 hours after admission to the intensive care unit. RESULTS Over the initial 3 collection points after cardiopulmonary bypass (mean duration, 131 minutes), the mean vasoactive-inotropic score decreased in the biventricular pacing group from 12.0 ± 1.5 to 10.5 ± 2.0 and increased in the standard of care group from 12.5 ± 1.9 to 15.5 ± 2.9. By using a linear mixed-effects model, the slopes of the time courses were significantly different (P = .02) and remained so for the first hour in the intensive care unit. However, the difference was no longer significant beyond this point (P = .26). CONCLUSIONS The vasoactive-inotropic score decreases in patients undergoing temporary biventricular pacing in the early postoperative period. Future studies are required to assess the impact of this effect on arrhythmogenesis, morbidity, mortality, and hospital costs.

331: A NOVEL CODE TEAM LEADER IDENTIFIER

www.ccmjournal.org Critical Care Medicine • Volume 46 • Number 1 (Supplement) Learning Objectives: Code team leader identification has been a long-standing obstacle in both simulated and real-life acute care situations. In this study, we developed a tangible object to clearly identify the code team leader and evaluated the effectiveness of this innovation in enhancing code leader identification. Methods: We designed a Code team leader card (CTLC) to clearly identify the leader while simultaneously providing valuable resuscitation information. The CTLC includes 3 different American Heart Association (AHA) Pediatric Advanced Life Support (PALS) algorithms located on the resuscitation cart for easy access during the assessment and treatment of clinically decompensating patients. Pediatric residents underwent scheduled simulations using the CTLC and were surveyed on the effectiveness of this innovation. The relationship between CTLC implementation and consistent leader recognition was evaluated using a chi-square analysis. Results: Prior to CTLC introduction, 131 residents completed surveys, and post-implementation, 41 residents completed surveys. Consistent recognition of a team leader increased significantly from 61.8% pre-CTLC to 80.5% post-CTLC (p = 0.027). Conclusions: Code team leader recognition significantly improved with the use of the CTLC. Furthermore, the CTLC had secondary benefits of enhancing team leader performance during a resuscitation by providing PALS algorithms and allowing the leader to focus on managing the code team rather than assisting with procedural tasks.

564: TEACHING DEATH AND DYING COMMUNICATION SKILLS THROUGH SIMULATION

Crit Care Med 2016 • Volume 44 • Number 12 (Suppl.) days. Patients who survived to discharge had lower APACHE II score compared with non-survivors (23.3 ± 5.7 vs. 28.1 ± 12.2, p<0.05). There was no significant difference in age, gender, body mass index (BMI) and Charlson Comorbidity Index.Conclusions: In critical illness, Do-Not-Resuscitate is a decision of endof-life care. However, aggressive care in ICU in certain patients was not definitely futile, and could bring probable survival benefits. Further evaluation about the cost-effectiveness of admission of DNR patients to ICU is required.