Preparing a new workforce to care for patients with cardiac implants

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rep anes grant surgery 550pxEvery year, surgeons worldwide place some 1.7 million pacemakers, defibrillators and cardiac loop recorders. Known collectively as cardiac implantable electronic devices (CIEDs), these machines control or correct abnormal heart rhythms and prevent heart attacks, atrial fibrillation and other conditions. In the United States, more than 300,000 people receive new CIEDs each year, with those numbers expected to increase as older adults comprise a larger share of the population.

Cardiac surgery presents particular challenges for patients with CIEDs. Electrical stimulation during a procedure may inhibit pacemaker functions in patients who rely on them and stop their heart from beating. Patients with defibrillators may encounter painful shocks invoked by the electrical stimulation used during surgeries. During open-heart surgeries different components of CIEDs may be displaced or dislodged, leading to fatal complications.

These are among the reasons CIED settings must be adjusted before surgeries and restored after surgeries. Failure to enable arrhythmia-detection functions in defibrillators after surgery may result in arrhythmias being unrecognized and untreated, with potentially fatal results. The interrogation, programming and restoration of CIEDs generally is done by representatives of device manufacturers, but these companies are short-staffed and employees are stretched thin, which contributes to surgical delays and potential patient-safety issues.

Filling a need

Ahmed Zaky, M.D., is assembling a multi-disciplinary team to tackle the problem, supported by a two-year, $100,000 grant from the Foundation for Anesthesia Education.

"The uniqueness of this collaboration is that it is investigator-driven rather than project-driven, setting an example for a multidisciplinary team. This gives everyone the opportunity to be creative in their field, rather than to simply serve as one piece of a single project.”

In 2017, Zaky, a professor in the Division of Cardiothoracic and Critical Care Anesthesiology, began extensive training and certification in pre- and post-surgical reprogramming for CIEDs. "I started this due to the shortage in device company representatives," Zaky said. "They are not available all the time, and cardiologists who can do this reprogramming do not have the time because of their busy schedules. Everyone has to wait until these services come and manage the devices during the procedure, and there are patient-safety issues if a device is put on different settings for surgery and then not restored after surgery. This created a need for anesthesiologists to take over that service."

The results, Zaky found, were promising: "Surgeons saw that patients were safer and there were no delays when we had the service taken over by a team of cardiac anesthesiologists," he said.

Ahmed Zaky, M.D.Ahmed Zaky, M.D.Zaky soon began an educational program and developed a curriculum to train more anesthesiologists to manage CIEDs. "Then we took it to a national level, with teaching workshops in annual meetings related to cardiac anesthesia along with publications," he said. Still, "there are few institutions in the nation that have a dedicated standardized curriculum for their cardiac anesthesia trainees on CIEDs. Additionally, these trainees have limited time to learn on these devices during their rotations.”

A new type of training for a new generation

So Zaky developed a new way to train the next generation of cardiac anesthesiologists: a smartphone-based app with a curriculum designed by Zaky and developed with nationally recognized UAB experts in education and computer science. In May 2021, Zaky received a two-year, $100,000 Research in Education grant from the Foundation for Anesthesia Education and Research for his project, "The Cardiac Implantable Electronic Device Application: A Novel Modality for Educating Cardiovascular Anesthesia Trainees." The foundation's grant is extremely competitive, Zaky said, so “it was a very pleasant surprise to see it approved on the first pass."

This is a unique collaboration between investigators from different fields with diverse expertise and backgrounds. Scott Snyder, Ph.D., professor in the School of Education and director of the UAB Center for Educational Accountability, is an expert in program evaluation and curriculum building. Yuliang Zheng, Ph.D., chair of the Department of Computer Science, and Ragib Hasan, Ph.D., associate professor and director of the department’s Secure and Trustworthy Computing Lab, make up the technology side of the team. "The uniqueness of this collaboration is that it is investigator-driven rather than project-driven, setting an example for a multidisciplinary team,” Zaky said. "This gives everyone the opportunity to be creative in their field, rather than to simply serve as one piece of a single project.”

UAB is a place where this kind of collaboration can happen, Zaky said: "We are able to push the boundaries and bridge gaps not only in the field of anesthesiology, but in education and computer science as well. This exemplary collaboration is likely to advance the fields of anesthesiology, medical education and computer science.”

Enhancing UAB’s culture of collaboration and innovation is a strategic objective of Forging the Future, UAB’s strategic plan. This multi-disciplinary project is a clear example of that objective and of UAB’s shared value of collaboration.