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Administration/What are ACLS or CPR requirements for anesthesiologists in ASCs?

QUESTION:

What are your recommendations as far as ACLS or CPR requirements for anesthesiologists in an ASC? We are requesting that our anesthesiologists take CPR or ACLS but some feel since they had this in their schooling and they work daily with the airway they do not need either. Any recommendations?  

-- From Diana McDaniel, R.N., M.S.N.,  Evansville, IN

REPLY:

I firmly believe that ACLS "certification" adds nothing to the abilities or resuscitation outcome of a well-trained anesthesiologist or CRNA. The ASA requirement (Office-based Surgery Core Principles. AMA report: www.ASAhq.org/Washington/AMACorePrinciples.pdf) for at least one practitioner giving moderate or greater office sedation to be ACLS trained and the rest BLS trained, is to ensure that surgeons and other perioperative personnel possess some basic airway and resuscitation skills. These skills are inherent in anesthesia training. On the other hand, all practitioners administering drugs need to be trained in acute resuscitation and the ACLS/BLS requirement is at least a step in the right direction.  A poorly-trained, anesthesia-provider may need the update that ACLS will deliver and is also less likely to impede well-trained rescuers during the resuscitation of an arrested patient. Furthermore, an ACLS-certified practitioner is less open to criticism if there is a bad outcome after an operating room disaster.

Epidemiologically, it is not reasonable to expect that ACLS protocols, which were developed to increase the survivability of sudden cardiac death in the general population, would be applicable or perhaps even useful in a perioperative arrest. The treatment of perioperative arrests is highly dependent upon what has just transpired in the operating room. Anesthetic drugs have significant physiologic effects that need broad understanding and specific skills to manage, especially when things go wrong. Yet, it would be difficult to convince a jury that anesthesia training was sufficient, even though we all know it should be more than adequate.

In summary, while I do not feel that ACLS training is necessary or even sufficient for a good outcome from perioperative resuscitation, it is almost essential that we all strive for certification to reassure the public that we are adequately trained and capable of dealing with any problems that may arise during their procedure.

-- From Peter H Norman, M.D., Houston, TX

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