Journal of Surgical Simulation 2021; 8: 77 - 83

Published: 11 February 2022


Original article

A prospective cohort study evaluating the effectiveness of cardiac arrest and resternotomy simulation training of the post-cardiac surgery recovery team

Andrew G. Keogan, Richard M. Maier Jr. and Molly M. Hagen
Corresponding author: Andrew G. Keogan, 1664 N Virginia St, Reno, NV 89557, USA. Email:


Objective: The management of cardiac arrest in after cardiac surgery requires resuscitative efforts that deviate from the established American Heart Association Advanced Cardiac Life Support guidelines (ACLS) guidelines. The Society of Thoracic Surgeons (STS) and the European Association of Cardiothoracic Surgery have established guidelines for managing cardiac arrest and resternotomy in these patients and recommend regular practice by the multidisciplinary recovery team. This study, conducted at a single institution, aimed to identify areas of deficiency in knowledge of STS guidelines and evaluate the effects of simulation on comfort with the procedure and perceived value of training.

Methods: A before and after study was performed whereby participants were given hands-on resternotomy training and completed pre- and post-training surveys that assessed knowledge of the STS protocol, comfort level, and value perception. The training, simulation, and survey were conducted in a clinical simulation laboratory. Study participants included registered nurses, attending physicians, resident physicians, pharmacists, and respiratory therapists. The training consisted of a lecture followed by a high-fidelity simulation of a cardiac arrest leading to bedside surgical exploration utilizing a resternotomy manikin.

Results: Participants’ baseline scores of knowledge of STS guidelines averaged 53.3%. This average increased to 81.3% after training, with improvement on four of the six knowledge questions achieving statistical significance (P < 0.001 in all cases). Participant comfort with the STS protocol and the resternotomy procedure increased significantly (both P < 0.0001), as well as value perceptions of the simulation training (P < 0.03) and utilizing a resternotomy capable manikin (P < 0.02).

Conclusions: Participants’ inadequate knowledge of STS guidelines suggests that delivering education to all post-cardiac surgery team members would be beneficial and is desired by clinicians. High-fidelity resternotomy simulation has favorable effects on participant comfort and their perceived value of training and can be made affordable by modifying widely available supplies.


ICU resternotomy; cardiac surgery simulation; resternotomy manikin; post-cardiac surgery cardiac arrest; multidisciplinary simulation