The Authors Respond

Thank you very much for your comments and insightful questions. Since we implemented the simulation training, which we complete twice a year, we have not had to perform an emergent resternotomy in the intensive care unit (ICU). Having said that, the 2017 Society of Thoracic Surgeons postcardiac surgery arrest protocol1 has been a part of the simulation training, and we have seen that all staff follow this specialized cardiopulmonary rescucitation protocol when needed (which is more often than having to perform a resternotomy). This situation was certainly not the case before we implemented our simulation training, when most ICU staff would follow the traditional Advanced Cardiac Life Support protocol. There is definitely a sense of comfort among our nursing staff and advanced practice providers with both postcardiac surgery cardiac arrest resuscitation and being prepared to perform a sternotomy in the ICU. The didactic slides, followed immediately by simulation scenarios that necessitate emergent resternotomy, have been critical in achieving this degree of comfort with such daunting clinical scenarios.At our institution, we have 24-7 in-house advanced practice provider coverage in our cardiac surgical ICU, in addition to a cardiac surgical fellow trainee and cardiac surgery staff who are available at any time.