Cangrelor Bridging Within 6 Months of a Drug-Eluting Stent in a Patient for Emergency Cervical Spine Surgery: A Case Report.

The recommended duration of dual antiplatelet therapy after drug-eluting stent placement presents a dilemma for patients with recent stenting who require urgent or emergency noncardiac surgery. We present the case of a patient with recent drug-eluting stent placement (<6 months) on dual antiplatelet therapy who underwent successful emergency cervical spine surgery with antiplatelet therapy bridged using cangrelor, an intravenous P2Y12 inhibitor antiplatelet agent. Our experience illustrates the multidisciplinary approach to a patient with high thrombotic and bleeding risk who underwent neurosurgery off both aspirin and a P2Y12 inhibitor.

Comparing the effectiveness of a hybrid simulation/lecture session versus simulation alone in teaching crew resource management (CRM) skills: a randomised controlled trial.

Introduction: Various methods have been used to teach crew resource management (CRM) skills, including high-fidelity patient simulation. It is unclear whether a didactic lecture added on to a simulation-based curriculum can augment a learner's education. Methods: Using an already existing simulation-based curriculum for interdisciplinary teams composed of both residents and nurses, teams were randomised to an intervention or control arm. The intervention arm had a 10 min didactic lecture after the first of three simulation scenarios, while the control arm did all three simulation scenarios without any didactic component. The CRM skills of teams were then scored, and improvement was compared between the two arms using general estimating equations. Results: The differences in mean teamwork scores between the intervention and control arms in scenarios 2 and 3 were not statistically significant. Mean scores in the intervention arm were lower than in the control arm (-0.57, p=0.78 for scenario 2; -3.12, p=0.13 for scenario 3), and the increase in scores from scenario 2 to 3 was lower in the intervention arm than in the control arm (difference in differences: -2.55, p=0.73). Conclusions: Adding a didactic lecture to a simulation-based curriculum geared at teaching CRM skills to interdisciplinary teams did not lead to significantly improved teamwork.