Cardiac Anesthesia

[bryanb5]

I'm hoping to go to CRNA school and I am interested in Cardiac Anesthesia. A few years ago when I was an undergrad, I spent the summer shadowing CRNAs and MDAs in the OR at two local hospitals. None of the CRNAs did Cardiac cases. At the teaching hospital, the cardiac volume was very low and it was only Anesthesia residents. At the private hospital, the cardiac volume was high but again, it was only the MDs (most of whom were fellowship trained).

I've seen places online that say they use CRNAs for hearts, so I know that there are some out there, my question is, do any of you do hearts and if so do you do them exclusively or do you do other types of cases as well?

Do you use intraoperative TEE? Is this a procedure that a CRNA can perform and bill for? How did you learn? Was it included in your program? OJT?

I read something the other day that TEE may be a good replacement for PA cath (considering the higher risk associated with PA cath). Thoughts?

Also, again as an undergrad, I worked as a CNA/ECG Tech in a Cardiac unit and when I left, we were just starting to use Impediance Cardiography in the hopes of replacing PA caths. I've been out of the cardiac loop for the past few years now (and where I am is kind of slow to adapt to new things anyway... :-(, is this something that is catching on? Anyone have any experience with it? Any use it intraoperatively?

Bryan

[Idaho-RN]

Dear Bryan,

I cannot give you any details as far as CRNA experience, as I have yet to start school. But I currently work in a CVICU in Boise, ID. We have CRNA's do the majority of our open heart cases. I believe they do the TEE. Our surgeons are just now starting to do away with the PA caths on a large number of their cases, of course this is related to the pt's comorbidities. I think our surgeons are picky about the CRNA's they let in the OR, but the word on the street is that there are not a lot of CRNA's that want to do the CV cases. I don't know why, because our surgeons are great to work for on my end, but I heard they are totally different in the OR. Sorry I couldn't be of more assistance.

Phil

[NursePink]

Hi Bryan

I do plenty of open hearts... generally between 2 to 5 per week. It is not an exclusive deal for me, but I'm one who generally does more than some of my colleagues. This is mostly b/c I'm newer, was trained @ a cardiac facility, & the majority of my 7 years of ICU experience was CV. I do the majority of the case start to finish (lines, on pump, off pump). There is an MDA 'medically directing' me, but honestly... there usually ain't much 'medical direction' going on. I do a mediocre job with a TEE. That is not part of anesthesia training for CRNAs. I'm learning to do it & the different views for myself... not b/c it's an expectation. To this point... I have not known of a place where it is the responsibility of the CRNA to do/interpret the TEE. If we choose not to use a PA catheter, we only utilize a central line. TEEs in my facility are reserved for valve replacements, incredibly poor LV function, or special circumstances that arise where overall function of the myocardium is in question.

Honestly... I love doing cardiac anesthesia. I'm lucky b/c I work with very cool CV surgeons. However, I wouldn't wanna do it on a daily basis. It's good to change things up IMHO & utilize all the skills that you've learned. After awhile... hearts become very 'cookbook'.

Good luck to ya!

[heartICU]

I'm hoping to go to CRNA school and I am interested in Cardiac Anesthesia. A few years ago when I was an undergrad, I spent the summer shadowing CRNAs and MDAs in the OR at two local hospitals. None of the CRNAs did Cardiac cases. At the teaching hospital, the cardiac volume was very low and it was only Anesthesia residents. At the private hospital, the cardiac volume was high but again, it was only the MDs (most of whom were fellowship trained).

I've seen places online that say they use CRNAs for hearts, so I know that there are some out there, my question is, do any of you do hearts and if so do you do them exclusively or do you do other types of cases as well?

Do you use intraoperative TEE? Is this a procedure that a CRNA can perform and bill for? How did you learn? Was it included in your program? OJT?

I read something the other day that TEE may be a good replacement for PA cath (considering the higher risk associated with PA cath). Thoughts?

Also, again as an undergrad, I worked as a CNA/ECG Tech in a Cardiac unit and when I left, we were just starting to use Impediance Cardiography in the hopes of replacing PA caths. I've been out of the cardiac loop for the past few years now (and where I am is kind of slow to adapt to new things anyway... :-(, is this something that is catching on? Anyone have any experience with it? Any use it intraoperatively?

Bryan

The facility I trained at has an extremely large cardiac program. So much, in fact, that it is actually a separate department within the division of anesthesiology. It has its own MDs and CRNAs (and residents and fellows that rotate through). There are twenty CRNAs in that department, and they do cardiac and thoracic exclusively. I am not sure, but I think we are one of the few places in the country that separate our departments like that (we have three depts - peds, cardiac, and general anesthesia).

We typically use swans for most patients, unless they are very young or healthy (which is rare). Our typical patients were redos, sometimes 3,4,5th time redos, with multiple comorbidities and EFs in the 20-30% range. Every once in a while you would get a primary valve in a 40 year old - it was like a Christmas present:-)

If they were opening the chest, they also got a TEE. I work in the general anesthesia department, not the cardiac one, so I am not sure if they used TEE for OPCAB, as I somehow managed to dodge doing one during my training..:-) We were not trained in TEE, but many of the CRNAs that taught me were able to look at the echo and see/show me things before the cardiologist or anesthesiologist came in to officially "read" the echo. I don't think we can bill for it, but I could be wrong.