Authors: Amy Babb, MD - Monroe Carell Jr. Children's Hospital at Vanderbilt University Medical Center AND Calvin Kuan, MD - Lucile Packard Children’s Hospital Stanford
A 2023 expert consensus paper recommended that centers performing pediatric heart surgery have a formalized congenital cardiac anesthesia team. To be designated as a Comprehensive Care Center, what is the MINIMUM number of congenital cardiac anesthesiologists required as part of the anesthesia team?
EXPLANATION
In 2023, experts in all domains related to congenital heart surgery produced recommendations for centers performing pediatric heart surgery in the United States.1 Within this publication, there is a framework for defining programs as “Essential Care Centers” and “Comprehensive Care Centers” followed by further description of the necessary resources and staff needed within each category. For example, recommendations for becoming a “Comprehensive Care Center” include performing a minimum of 200 index operations compared to an “Essential Care Center” performing a minimum of 75. General recommendations for infrastructure include hospital resources, non-cardiac subspecialty availability, components of a heart center, quality and safety initiatives and patient follow up. In addition, there are recommendations for the various specialties integrally involved in pediatric heart surgery. Intensive care, perfusion, cardiac catheterization, electrophysiology, imaging and pediatric cardiac anesthesiology are included and described individually.
Within the section about anesthesia services, the group recommends a dedicated congenital cardiac anesthesia team for both Comprehensive and Essential Care Centers with a call schedule providing 24/7/365 coverage for emergency cases. A Comprehensive Care Center should have a minimum of 3 or more congenital cardiac anesthesiologists to allow coverage for scheduled and emergent cardiac procedures, as well as noncardiac procedures. An Essential Care Center should have a minimum of 2 team members to ensure adequate coverage.
Other recommendations regarding anesthesia services for Comprehensive Care Centers include:
• Team members’ primary clinical focus should be caring for patients with congenital heart disease
• Each team member should do a minimum of 25 index cases per year to maintain proficiency
• Provide preoperative consultative services for patients with CHD undergoing noncardiac procedures
• Participate in multidisciplinary heart center conferences, especially for surgical planning
• Participate in the anesthesia component of the STS Congenital Heart Surgery Database
• Track standard clinical outcomes and review them at least twice a year
Recommended training and/or experience for members of the congenital cardiac anesthesia team include:
• 12-month ACGME pediatric cardiac anesthesia fellowship
• OR at least 12 months of post-residency training in pediatric anesthesia or adult cardiac anesthesia AND at least 6 months of training in pediatric cardiac anesthesia
• OR at least 3 years' experience with cardiopulmonary bypass and catheterization procedures in pediatrics AND be an active member of the service.
One congenital cardiac anesthesiologist is thus considered insufficient to provide the recommended 24/7/365 coverage and cover vacation/sick time. At least 2 congenital cardiac anesthesiologists are recommended for an Essential Care Center and 3 or more are recommended for a Comprehensive Care Center performing pediatric heart surgery.
REFERENCES
1. Backer CL, Overman DM, Dearani JA et al. Recommendations for Centers Performing Pediatric Heart Surgery in the United States. World J Pediatr Congenit Heart Surg. 2023 Sep;14(5):642-679. doi: 10.1177/21501351231190353. PMID: 37737602.
