Malignant Hyperthermia - A Plan for Improvement

Abstract

Purpose: Malignant hyperthermia is a rare crisis associated with anesthesia that boasts an 80%fatality rate if left untreated. The purpose of this doctorate of nursing practice project was to evaluate impact of multimodal training and protocol availability on malignant hyperthermia management. Ultimately, the goal was to demonstrate improved provider competence to strengthen the recommendation for standardized malignant hyperthermia policy within the hospital. With this change, lives could be saved. Background: Malignant hyperthermia is a life-threatening response to triggering pharmacological agents. Triggering agents include all the contemporary anesthetic gasses used in the United States in addition to succinylcholine – a drug used to induce paralysis during induction of anesthesia. The pathology of malignant hyperthermia is a hypermetabolic state which confers electrolyte disturbances, rapid hyperthermia, cardiac dysrhythmias, muscle rigidity, hypertension and tachypnea. Methods: This quality improvement project started with optional use of a protocol, developed by Malignant Hyperthermia Association of the United States, during a live simulation training. Following the 20-minute simulation, eight anesthesia providers were debriefed and a short educational PowerPoint was presented. Finally, participants answered 15 survey questions to establish efficacy of the purported training session. Results: Results of the survey overwhelmingly support the use of a protocol for managing malignant hyperthermia. All (100%) providers had seen malignant hyperthermia in practice. Additionally, all providers agreed that, at minimum, annual training for all operating room staff would be valuable. All chose to use the optional protocol during practice simulation and subsequently agreed it was useful. All reported that they would choose to utilize the protocol if faced with this crisis in practice. And all felt more confident with recognition of malignant hyperthermia, dantrolene administration, and management of a crisis. Data suggests that participants increased their knowledge, competence, and confidence in managing malignant hyperthermia. Conclusion: Although rare, malignant hyperthymia can prove fatal despite being perfectly treatable. The Malignant Hyperthermia Association of the United States supports the use of a protocol in combination with simulation training for enhanced patient outcomes. The survey results of this quality improvement project provide additional support for the use of a protocol and simulation to improve crisis preparedness.