CRNAs doing Heart Cases Solo?

[UTMB2014]

https://www.aana.com/news/michigan-medicine-cardiac-crna-team-fills-need-for-providers-makes-history-at-their-hospital/

Can anyone who works at this hospital provide more insight?

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[HemeOncHopeful19]

 

[sevo00]

Pretty sure they are supervised and do not do the TEE. AANA is not going to tell you the whole truth

 

[ToKingdomCome]

No way U of M would allow CRNA to do a heart transplant solo lol

 

[Dr. Rude]

Pretty sure they are supervised and do not do the TEE. AANA is not going to tell you the whole truth

Of course they are supervised by anesthesiologists....

 

[ToKingdomCome]

I read the article and didn’t really interpret the language to suggest what OP is suggesting though I know AANA has done propaganda before

 

[Potatoman1800]

Doubt it’s solo. No thoughtful heart surgeon would tolerate that. Sounds like another BS amplification of their roles by the AANA by saying they were “a part of” these cases. This is the likely case of an academic center being too tight and now has to relent to having lesser people being supervised by anesthesiologists. Apparently placing a central line is enough for them to exclaim that crnas are just barely good enough to be there for induction, intubate and watch a cardiologist or CT anesthesiologist do a full TEE exam (ohh look at the pretty Doppler), followed by chilling on bypass and eventually wheeling the patient to the ICU. Yay to them right?

Not affiliated with this institution, so I’d love to hear what’s actually happening.

 

[Bertelman]

I mean, I work with anesthetists in the heart room. I wouldn’t write an article about it.

I’m more inteterested in why the Michigan residency program is flagging

 

[PpfSuxTube]

They're obviously not doing solo transplants. No surgeon is going to have their numbers destroyed like that. It sounds like they're filling the gaps when there's no resident and getting big heads over it... no big deal.

Nurses can do plastics etc etc cause the denominator is so big that even they can't skew a surgeons numbers enough to register, but when the denominator is 10 to 20 then no cardiac surgeon is going to take that risk, I hope!

 

[UTMB2014]

Disclaimer: not a cardiac anesthesiologist.

I had misinterpreted this article when I initially read it because the article failed to mentioned whether they were being supervised.

In our area, we do have crnas in the CABG room but they are always supervised.

This article seemed very misleading and really downplayed the role of the anesthesiologists in these cases. Typical crna propaganda

 

[UTMB2014]

One of my friends in another specialty texted me this and so I was reading this with “salty” glasses. Thanks for the clarification to the multiple posters above

 

[mmag]

Why did Michigan cut the number of anesthesia residents? Shouldn't they have increased the cohort size?

 

[Anesthesia_Guy]

Here come the predictable increase in complications....

 

[nimbus]

My group goes to an open staff surgicenter. We cover 1 room there. Other rooms covered by independent anesthesiologists and CRNAs. Last week one of the surgeons who was assigned a CRNA wanted an upper extremity block. CRNA did not do blocks. He asked my partner. Wasn’t his case so no block.

 

[nimbus]

Disclaimer: not a cardiac anesthesiologist.

I had misinterpreted this article when I initially read it because the article failed to mentioned whether they were being supervised.

In our area, we do have crnas in the CABG room but they are always supervised.

This article seemed very misleading and really downplayed the role of the anesthesiologists in these cases. Typical crna propaganda

Actually they acknowledge this in the article.

“Julvezan credited the anesthesia faculty at the University of Michigan for being extremely supportive of CRNAs taking on these cases. “Without the support of the entire team, this would have never worked.”

Sounds like a transition from attending+resident to attending+resident or attending+CRNA for cardiac cases. Probably due to manpower issues. Residents gotta get in the peds/OB/neuro/regional/pacu time too..lol. Can’t spend a disproportionate amount of time in the heart room. Agree with others that it’s not really newsworthy. I imagine many programs have had attending+CRNA in the heart rooms for years.

 

[vector2]

Actually they acknowledge this in the article.

“Julvezan credited the anesthesia faculty at the University of Michigan for being extremely supportive of CRNAs taking on these cases. “Without the support of the entire team, this would have never worked.”

Sounds like a transition from attending+resident to attending+resident or attending+CRNA for cardiac cases. Probably due to manpower issues. Residents gotta get in the peds/OB/neuro/regional/pacu time too..lol. Can’t spend a disproportionate amount of time in the heart room. Agree with others that it’s not really newsworthy. I imagine many programs have had attending+CRNA in the heart rooms for years.

I wonder if UofM, like many other academic programs, staffs their hearts 1:1. If so, the solution to the shortage was hiring a bunch of techs and have the cardiac docs sit the stool-- not break the precedent of having non-physicians in there.

 

[Beeftenderloin]

I wonder if UofM, like many other academic programs, staffs their hearts 1:1. If so, the solution to the shortage was hiring a bunch of techs and have the cardiac docs sit the stool-- not break the precedent of having non-physicians in there.

This. You can safely do solo big cases if you’re organized, and have a second set of hands that can ‘speak anesthesia’. Does not need to be a physician/CRNA/AA. My group has functioned like this for years. We have a dedicated tech that sets up the room, helps with lines and going to sleep, then comes back again when the clamp comes off in case we need help coming off.

Alternatively they could just stop supervising 1:1 if they still are (they were when I interviewed there a few years ago for ACTA). They were even 1:1:1 at times (Att, Fel, Res). Where I ended up training, especially second half of the year, it was very common for the cardiac attendings to be 1:2 and supervise a CA2/3 in a relatively straightforward heart then have a fellow (me) next door on there own in something more interesting. This is reasonable in academics, especially with fellows, and Michigan has 6 (assuming they’re filling, which could be a big assumption these days).

 

[Agast]

They probably have the cardiac fellows babysit them

 

[finalpsychyear]

This is only a matter of time before this becomes regular and unsupervised. They'll have cardiac CRNA fellowships if they don't have that yet. Docs already have lost the war on mid levels and they will start doing surgeries in the near future since non invasive procedures have already started. Glad I'll be out of this circus. If only we had unionized we wouldn't be eating the crumbs in the field in general.

 

[Lecithin5]

This is only a matter of time before this becomes regular and unsupervised. They'll have cardiac CRNA fellowships if they don't have that yet. Docs already have lost the war on mid levels and they will start doing surgeries in the near future since non invasive procedures have already started. Glad I'll be out of this circus. If only we had unionized we wouldn't be eating the crumbs in the field in general.

They already have peds anesthesia ‘fellowship’ programs for crnas.
I love it- teaching your replacement. No shame. No dignity.

 

[Lecithin5]

https://www.aana.com/news/michigan-medicine-cardiac-crna-team-fills-need-for-providers-makes-history-at-their-hospital/

Can anyone who works at this hospital provide more insight?

Funniest part of the article;
“…quickly got up to date on the latest education in the heart world…”

 

[finalpsychyear]

They already have peds anesthesia ‘fellowship’ programs for crnas.
I love it- teaching your replacement. No shame. No dignity.

Hope everyone is making their bank now. Might hurt less when salaries go down in the future when mid levels become self aware and start touting we r all equal "providers" in this team approach bs. I miss 80s medicine when you could chew out idiots for stupidity. Now if u do it with the wrong words, tone, facial expression, body language, or overly salivacious you will be sent to the chopping blocks.

 

[Porky_Pork_Chop]

Funniest part of the article;
“…quickly got up to date on the latest education in the heart world…”

Lmao what does that mean, if you can't read the echo you shouldn't be in the room

 

[vector2]

Funniest part of the article;
“…quickly got up to date on the latest education in the heart world…”

Lmao what does that mean, if you can't read the echo you shouldn't be in the room

The translation for "... quickly got up to date on the latest education in the heart world…" is "I read the institutional guideline document for the case that one of our docs researched, wrote, and uploaded to our anesthesia intranet"

 

[mmag]

University of Michigan has 27 residency spots this year. It use ot have 30 spots a year. The AANA article was right about the decrease in resident numbers. Anyone know why in the midst of unprecedented interest in anesthesiology from medical students, would a residency program cut the number of slots?

Anesthesiology programs with the most residency positions

According to FREIDA™ data, anesthesiology offers 1,935 first-year medical residency positions. Here are the programs offering the most opportunities.

www.ama-assn.org

 

[sevo00]

University of Michigan has 27 residency spots this year. It use ot have 30 spots a year. The AANA article was right about the decrease in resident numbers. Anyone know why in the midst of unprecedented interest in anesthesiology from medical students, would a residency program cut the number of slots?

Anesthesiology programs with the most residency positions

According to FREIDA™ data, anesthesiology offers 1,935 first-year medical residency positions. Here are the programs offering the most opportunities.

www.ama-assn.org

Funding issue?

 

[Anesthesia_Guy]

Hope everyone is making their bank now. Might hurt less when salaries go down in the future when mid levels become self aware and start touting we r all equal "providers" in this team approach bs. I miss 80s medicine when you could chew out idiots for stupidity. Now if u do it with the wrong words, tone, facial expression, body language, or overly salivacious you will be sent to the chopping blocks.

Most definitely. I'm done with this clown show in 2025 and am crossing days off on the calendar. "Chopping block" = mandated anger management course or lose your license.

 

[Ronin786]

Funding issue?

Sometimes it's because of the lack of categorical spots and not wanting advanced slots.

 

[nimbus]

University of Michigan has 27 residency spots this year. It use ot have 30 spots a year. The AANA article was right about the decrease in resident numbers. Anyone know why in the midst of unprecedented interest in anesthesiology from medical students, would a residency program cut the number of slots?

Anesthesiology programs with the most residency positions

According to FREIDA™ data, anesthesiology offers 1,935 first-year medical residency positions. Here are the programs offering the most opportunities.

www.ama-assn.org

Too big? Maybe they want a more close knit family feel

 

[<(^_^)>]

It’s a heart transplant. Michigan did a whopping 23 of those last year. If there wasn’t a resident free then the crna should have freed a resident to go do the heart transplant. Frankly there is no excuse for this and it reflects extremely poorly on the University of Michigan Anesthesiology department.

 

[HalO'Thane]

It’s a heart transplant. Michigan did a whopping 23 of those last year. If there wasn’t a resident free then the crna should have freed a resident to go do the heart transplant. Frankly there is no excuse for this and it reflects extremely poorly on the University of Michigan Anesthesiology department.

I would bet money that a Cardiac Anesthesia fellow was involved in a Heart Transplant at a place like U of M. Probably the one putting in the lines and doing the TEE. If that is the case, is there actually much benefit for a resident to be there? It would seem to me that if the Fellow is already there, then any additional provider would just be there for charting, setting up drips, and verifying blood products. Not sure how educational it would be.

 

[nimbus]

I would bet money that a Cardiac Anesthesia fellow was involved in a Heart Transplant at a place like U of M. Probably the one putting in the lines and doing the TEE. If that is the case, is there actually much benefit for a resident to be there? It would seem to me that if the Fellow is already there, then any additional provider would just be there for charting, setting up drips, and verifying blood products. Not sure how educational it would be.

Especially if the volume is only 22 cases/yr, it would be educational for a resident to be in the room even if they were essentially observing. How often would they get to see an empty chest and a fresh denervated heart?

 

[osumd]

This. You can safely do solo big cases if you’re organized, and have a second set of hands that can ‘speak anesthesia’. Does not need to be a physician/CRNA/AA. My group has functioned like this for years. We have a dedicated tech that sets up the room, helps with lines and going to sleep, then comes back again when the clamp comes off in case we need help coming off.

Alternatively they could just stop supervising 1:1 if they still are (they were when I interviewed there a few years ago for ACTA). They were even 1:1:1 at times (Att, Fel, Res). Where I ended up training, especially second half of the year, it was very common for the cardiac attendings to be 1:2 and supervise a CA2/3 in a relatively straightforward heart then have a fellow (me) next door on there own in something more interesting. This is reasonable in academics, especially with fellows, and Michigan has 6 (assuming they’re filling, which could be a big assumption these days).

Exactly. Anything to keep the attending from having to sit in a room…