Cardiac surgery team embraces life-changing innovations

Critical care team: Early adopters of enhanced recovery 

The Libin Cardiovascular Institute’s Cardiac Intensive Care Unit (CICU) team have historically been early adopters of techniques and systems that enhance recovery after surgery. Dr. Ken Parhar, MD, the director of Cardiac Clinical Care, says the Calgary team is unique because, unlike other surgical centres, the nine physicians that cover the CICU are highly specialized to treat patients after surgery, with training in life-saving techniques like ECMO (extracorporeal membrane oxygenation), an advanced therapy used to do the work of the heart and lungs when a patient's organs are too weak to work on their own.

Parhar notes Calgary’s Department of Critical Care pioneered the unique model to ensure patients receive the best treatment possible. 

“We have been very committed to modernizing our workforce to ensure they have the most up-to-date skills possible,” says Parhar. “With that comes the ability to enhance recovery, diagnose patients quicker and tailor treatments in a precise way.”

The critical care team is involved in caring for the approximately 1,800 patients who receive care in the CICU at Foothills Medical Centre each year. The team is also involved in numerous research projects and clinical trials with the goal of improving patient outcomes. 

Formalizing Enhanced Recovery After Surgery

Launched by the division of Cardiac Anesthesia and led by a team of researcher-clinicians within the Institute, the Cardiac ERAS® (Enhanced Recovery After Surgery) program was amongst the first-of-its-kind in Canada.  The program formalized processes with the goal of improving experiences and shortening recovery time for Calgary cardiac surgery patients by questioning all aspects of care and making small improvements that add up to big gains.

Anesthetist and researcher Dr. Alex Gregory, MD, is a lead of the program and says it addresses all aspects of the patient experience, from pre- to post-surgery care. ERAS addressed topics like: are patients being extubated within a standard length of time; do they have good pain control following their surgery, and are they able to return home sooner? 

As part of the ERAS pilot project launched in 2020, the team created a web-based app used by staff in the Cardiovascular Intensive Care Unit (CVICU) at the Foothills Medical Centre that provided a checklist for providing patient care post-surgery. During the pilot program, the team measured 200 data points in 185 patients—ranging from opioid use, to length of stay, to patient-reported pain levels—to allow them to assess whether their evidence-based protocols were occurring for each patient, and, if not, why. 

Next steps for the program include implementing the elements that worked into the Alberta Connect Care system so they can become standardized across Alberta; completing a survey to engage with patients, health-care providers and others to determine the best tools to measure patient reported outcomes to determine the quality of patient recovery after surgery; and continue working with partners on a first-ever randomized control trial looking at predictive technology to help manage hemodynamics (blood flow) in the Cardiovascular Intensive Care Unit. 

Cardiac anesthesia: adopting techniques to enhance recovery 

With Director Dr. Christopher Prusinkiewicz, MD, at the helm, the Division of Cardiac Anesthesia plays a critical role in enhancing recovery after surgery. The group not only launched the formal Cardiac ERAS program, but Calgary’s cardiac anesthetists are early adopters of using regional anesthesia techniques for minimally invasive cardiac surgery. 

The techniques, which involve blocking pain nerves using local anesthetics, decrease both patient discomfort and narcotic use, allowing patients to be woken up and extubated earlier. 

“Because patients are more comfortable, they can get up and move faster,” says Prusinkiewicz. 

The team also has an active perioperative blood conservation program, which looks to identify and treat anemic patients prior to surgery with the goal of decreasing the need for blood transfusions. By avoiding transfusions, patients have more energy, have less risk of developing infections and have a lower mortality rate. 

Fast track protocol 

Calgary’s minimally invasive cardiac surgery team is continuing the work of enhancing recovery after surgery. The team implemented a fast-track protocol for minimally invasive mitral surgery in September 2022. 

Designed by a group that includes surgeons, physicians, nurses, physiotherapists, and other allied health professionals within the Libin Cardiovascular Institute, the fast-track protocol further streamlines the process following surgery. Tubes, lines and drains are removed sooner, pain medications are reduced faster, and patients are encouraged to get up and move around on the day of their surgery.

A study of the protocol reveals it’s a success. Patients are leaving the intensive care unit faster, going home sooner and hospital readmission rates have decreased. 

Read more about the Libin Cardiovascular Institute's Top 20 Achievements of the last 20 years here.