November 16, 2012
EDMONTON — Charlie’s the first of his kind in the world — a mannequin with a heart and circulatory system that allows cardiac surgeons and their entire medical team to practise a rare but life-saving procedure: an emergency sternotomy, in which the chest and ribcage are cracked open quickly to allow for heart massage or internal defibrillation to restart the heart.
Created in Edmonton by eSIM, the provincial simulation program of Alberta Health Services (AHS), Charlie is already proving an invaluable hands-on training tool for heart surgeons who are forced — in a life-or-death scenario where seconds count — to rush a heart onto a bypass pump to stabilize their patient when bleeding or complications occur after a coronary artery bypass graft (CABG). The sooner the patient can be stabilized, the better the outcome.
“The procedure of opening a chest in the operating room is one that any cardiac surgery resident gets to practise many times in elective cases, but the process of doing that in an ICU during the resuscitation of a crashing patient is something else entirely,” says Andrew Reid, Charlie’s inventor and an eSIM consultant.
“There’s not only the need for speed but you’re out of your environment.”
Charlie is believed to be the world’s first simulation model specifically designed to allow an entire medical team to practise this complex, infrequently performed procedure in a real, working environment.
“We rarely have to resort to an emergency sternotomy to resuscitate a patient but, when we do, it is a very efficient way of massaging the heart after cardiac surgery,” says Dr. Rod MacArthur, Cardiac Surgery Program Director for Mazankowski Alberta Heart Institute.
Don’t call Charlie cheap — but for a medical simulator, he really is.
Put together for $2,000 using local hardware store materials, Charlie can be intubated, has metal ribs and sternum, boasts a heart and major blood vessels hand-crafted from special rubbers that can grip a bypass-pump cannula (big needle), take a surgeon’s stitch and be pressurized to flow ‘blood’ at up to five litres a minute, simulating a real human body.
Refreshing Charlie’s body parts costs about $100 per simulation session. As well, a realistic vital signs monitor displays the physiology of a crashing patient so the team can make the snap decision to perform an emergency sternotomy.
“We strived to create a tissue model that feels right, in a sensory way, for the surgeon, with anatomy that looks right to the surgeon’s eye,” says Reid. “We have to be able to fool the machine (bypass pump) as well as the human with the scalpel.”
Charlie’s skin is made of silicone rubber. Once surgeons cut through the skin, there’s a forged metal ribcage, welded to a sternum, bolted into the mannequin. With a rib retractor, it splits and spreads with the same tactile resistance found in a human chest.
Reid worked with Dr. MacArthur and Dr. Gurmeet Singh, a cardiac surgeon and intensivist at the Mazankowski, to build this training tool.
“For me, this project really demonstrates the commitment of the Mazankowski to training the future generations,” says Dr. MacArthur. “In this simulation, we can have operating room and intensive care unit nurses, physicians, surgeons, intensive care staff, anesthetists, respiratory therapists, perfusionists and more all working together here and sharpening team skills.”
And doing so with speed and urgency, adds Dr. Singh.
“In cardiac surgery and in critical care, we work very closely in a team environment that necessitates communication, rapid delivery of care and rapid decision-making and collaboration between multiple disciplines and in multiple environments,” he says. “Simulation allows us to bring other people into the training process.”
Charlie was first used a month ago at the Fifth Annual Cardiac Surgery Residents Workshop at the Mazankowski, which brought together surgical residents and fellows from Calgary and Edmonton for a Saturday of educational lectures and a sternotomy simulation.
The ongoing goal of eSIM is to provide realistic, instructor-led health care environments where learners are encouraged to exercise their clinical skills in responding to rare, life-threatening conditions without placing a human patient at risk. Currently, eSIM offers educational experiences that positively impact Albertans of all ages, from obstetrics to end-of-life care.
“There are not enough accolades to describe Andrew’s accomplishment,” says Dan Huffman, Director, eSIM North, based in Edmonton. “For three years, he has worked to educate himself in the use of special polymers that replicate tissues, in the use of advanced software programs that generate, monitor and report physiologic and instrument activity — and he even took a blacksmith course so that he could manufacture a ribcage that can withstand CPR, while also being able to be ‘surgically opened’ in an emergency.”
Alberta Health Services is the provincial health authority responsible for planning and delivering health supports and services for more than 3.8 million adults and children living in Alberta. Its mission is to provide a patient-focused, quality health system that is accessible and sustainable for all Albertans.
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