CCAS Think-Tank for Pediatric Specialists

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					CCAS: Think-Tank for Pediatric Specialists
Rose Fox

Riding the recent wave of developments in neonatal cardiac surgery and cardiopulmonary
bypass, pediatric anesthesiologists and hospitals in the United States, Canada and
Australia have teamed up to form the Congenital Cardiac Anesthesia Society (CCAS). The
primary goal of the CCAS, an offspring of the Society for Pediatric Anesthesia (SPA), is to
educate and train anesthesiologists on the latest diagnostic and therapeutic modalities
relating to congenital heart surgery, pediatric cardiology and cardiac anesthesia, and
cardiac intensive care.
Over the past decade, surgical treatment of congenital heart disease (CHD) has
increased dramatically, said Dean Andropoulos, MD, chief of anesthesiology and director
of pediatric cardiovascular anesthesiology at Texas Children’s Hospital in Houston and
president of the CCAS. “Congenital heart disease is the most common birth defect
requiring invasive treatment in the first year of life,” Dr. Andropoulos said. “Most lesions
are now corrected in early infancy, with a complete repair if at all possible, and virtually
all patients—even the very most complex who formerly were inoperable—are treated
surgically and in the catheterization laboratory. This has presented a large population of
very complex and ill patients for the pediatric cardiac anesthesiologist, and specialized
expertise is critical to ensure the best possible outcomes.”
In addition, Dr. Andropoulos said, the growing population of adults with CHD presents a
complicated set of problems requiring specialized knowledge. “It is apparent that having
one organization dedicated to anesthesia for these patients is critically important, given
the rapid changes in the field.”
Congenital heart defects of any severity occur in an estimated 75 children per 1,000 live
births, although the rate for moderate and serious problems is closer to six per 1,000 (J
Am Coll Cardiol 2002;39:1890-1900, PMID: 12084585).
Numerous recent advances have been seen in pediatric anesthesia and cardiopulmonary
bypass techniques, as well as with transesophageal echocardiography, neurological
monitoring and other types of specialized monitoring. Pediatric anesthesiologists
encounter patients with many different kinds of CHD, from single-ventricle lesions, such
as hypoplastic left heart syndrome, to two-ventricle lesions, such as transposition of the
great vessels.
Education, Training Core Concerns
Given this tremendous variety, and with research and surgical techniques advancing so
rapidly, centralization of resources and development of specialized educational curricula
have become necessary to ensure that anesthesiologists can keep up with the demands
of the field.
To this end, the CCAS has begun organizing Pediatric Cardiac Anesthesia Conferences,
the first of which was held in Phoenix on March 8 to coincide with the joint winter
meeting of the SPA and the American Academy of Pediatrics. CCAS members are also
collaborating with the SPA to develop education and training guidelines for teaching
anesthesia fellows and residents about working with patients who have CHD. Their aim is
eventual accreditation of Pediatric Cardiothoracic Anesthesiology Fellowships by the
Accreditation Council for Graduate Medical Education.
The CCAS was officially launched in December 2005 and has grown to include 200
individual members and 21 charter institutional members. Dr. Andropoulos said he hopes
that CCAS will soon grow to include as many as 500 individual members as word spreads
about the group’s achievements and plans.
“The formal decision to create a separate society was made in December 2004, when the
faculty from our Pediatric Cardiac Anesthesia Conference, held in conjunction with the
Pediatric Cardiac Intensive Care Society, met to evaluate that conference and plan future
educational efforts,” Dr. Andropoulos said. “It became clear that a society was needed,
first for the educational efforts, and then for the other functions noted in our mission
Those functions include collaboration and coordination within the CCAS and with other
organizations, encouraging and collating research in the field of pediatric cardiac
anesthesia, and patient advocacy.
Adults Patients Not Ignored
An important part of the CCAS mission is to educate members and other groups on the
treatment of adult patients with CHD. “This is a growing population, with complex
anatomy, undergoing surgeries that are not commonly performed, and thus not well
understood, in the adult cardiac anesthesia world,” said Dr. Andropoulos. Although all
CCAS members currently must also belong to the SPA, and there is a strong focus on
pediatric patients, pediatric anesthesiologists are uniquely able to educate the general
anesthesiology community on the latest developments in surgical treatment of CHD and
their applicability to adolescent and adult patients. The CCAS is working closely with the
Society of Cardiovascular Anesthesiologists (SCA), and presented a workshop on adult
CHD at the SCA’s 2006 annual meeting. Another workshop is planned for the 2007 SCA
meeting in Montreal.
These workshops are organized by Dr. James DiNardo, a senior associate in cardiac
anesthesia at Children’s Hospital in Boston and the CCAS treasurer. He said that
Children’s Hospital’s Cardiac Anesthesia Service has seven members who work solely
with infants and children with CHD. “We care for over 3,000 children a year for cardiac
surgery, noncardiac surgery, and related diagnostic procedures,” said Dr. DiNardo. Many
CCAS board members also work in some of the largest pediatric cardiac services in North
America and together see thousands of patients annually. “I would like us to have a
forum for sharing information and conducting multicenter trials that we have not had
until the formation of this group.”
Dr. Andropoulos agreed that collecting and sharing clinical and research data would be a
crucial function of the CCAS. “One of the very most important initiatives is the Congenital
Cardiac Anesthesia Database,” he said, naming the multinational database that would
track the anesthetic care of patients with CHD. “This kind of a comprehensive database
would be difficult to organize for the entire SPA, because there would be too many cases
and institutions.”

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