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79 Improving management of malignant hyperthermia using point-of-care simulation training
  1. R Williams,
  2. A McNutt,
  3. C Lobo,
  4. K Kamalanathan
  1. Bristol Medical Simulation Centre, UK


implementation of treatment has reportedly reduced mortality from 70% to <5%, however.1 During a point-of-care simulation of malignant hyperthermia in an operating theatre, it became evident to faculty that staff were unclear on the management MH as per current national guidelines, and on the location of drugs and equipment required to implement it. Under similar conditions, this would have led to a potentially catastrophic delay in treatment of a living patient. The scenario was ended at 11 minutes, at which point dantrolene vials had not been retrieved, and external cooling was not started. We therefore set to instigate system changes to improve MH management and test them using medical simulation.

Following the initial simulation, the MH scenario was run a further three times over a six month period as part of the our hospital’s point-of-care simulation programme. During each scenario, faculty recorded the time from diagnosis to commencement of internal and external patient cooling, and administration of intravenous dantrolene. Interventions employed included a refrigerated ‘Malignant Hyperthermia Draw’ containing current MH guidelines, multiple ready-cooled intravenous fluid bags, external cooling packs and a detachable card to facilitate retrieval of dantrolene vials from the intensive care unit.

Initial results indicate a marked reduction in time from diagnosis to instigation of treatments. Statistical evidence is unavailable at the time of writing but will be published in the poster presentation.

Management of clinical MH lends itself to simulation training being rare and very acute in onset. It necessitates immediate intervention, requiring effective communication and team-working skills. Although quality improvement has previously been used to improve management of several anaesthetic emergencies, to the best of our knowledge this is the first study to use simulation to optimise management of MH.


  1. Ali SZ, Taguchi A, Rosenberg H. Malignant hyperthermia. Best Pract Res Clin Anaesthesiol 2003;17:519–33.

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