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.