2025 Poster Presentations
P419: ICA INJURY IN ENDOSCOPIC ENDONASAL SURGERY: AN INTERPROFESSIONAL TEAM SIMULATION MODEL
Akshaya Raman, BA1; Benita Valappil, MPH2; Carl H Snyderman, MD, MBA2; 1University of Pittsburgh School of Medicine; 2Department of Otolaryngology, Eye & Ear Institute, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
Background: Endoscopic endonasal surgery (EES) has revolutionized the treatment of tumors and inflammatory diseases of the anterior skull base but carries the risk of potentially fatal internal carotid artery (ICA) injury. Effective interprofessional teamwork among surgeons, anesthesiologists, neurophysiologists, nurses, and scrub technicians in the operating room is essential for successful management of this feared complication. Interprofessional education (IPE) programs with simulation components improve collaborative attitudes, role delineation, and patient outcomes in medical crises. However, interprofessional team simulation training for ICA injury in EES remains unexplored.
Objectives: To create an evidence-based, reproducible model for interprofessional team simulation of ICA injury during EES and to assess the efficacy of a curriculum that includes didactic education, high-fidelity interprofessional simulation, and team debriefing, aimed to improve team response.
Methods: We researched various healthcare team training models, including the core TeamSTEPPS principles, peer-reviewed team scoring modalities, and existing ICA injury simulation models to inform our curriculum. Interviews with OR personnel during EES cases helped develop a role-specific timeline of responsibilities during an ICA injury. Consensus on pre-operative preparations and intra-operative management protocols from a survey of experienced skull-base surgeons guided the creation of a technical scoring checklist. Observations from a cadaveric ICA injury exercise for surgeons, conducted at our institution’s skull-base surgery workshop, also informed the inclusion of common errors committed under stress in our simulation scenarios.
Results: Our designed curriculum consists of the following:
1. Participants, including surgeons, nurses, scrub technicians, anesthesiologists, and neurophysiologists, receive pre-course reading materials on vascular injury during EES and each team member’s role in responding to ICA injury. This represents the current standard of interprofessional education on ICA injury.
2. Participants engage in our team simulation model replicating ICA injury scenarios in a high-fidelity operating room. Independent reviewers score team performance using the Mayo High Performance Teamwork Scale (MHPTS) and a technical ICA management protocol checklist, followed by a team debrief.
3. Participants complete our curriculum, encompassing a didactic portion of interactive lectures featuring videos depicting both correct and incorrect handling of ICA injuries, with pauses to discuss TeamSTEPPS principles.
4. Participants engage in a second simulation with a varied ICA injury scenario, scored again using the MHPTS and technical protocol checklist, followed by a debrief.
Conclusion: ICA injury, a feared complication of EES, requires robust, hands-on training for the entire interprofessional team. Our designed curriculum, combining a collaborative didactic education with a high-fidelity interprofessional simulation, is expected to enhance team performance in ICA injury management during EES.