The CARE educational strategy behind CSU-ALS training. Evidence-based, team-based preparation for arrest after cardiac surgery.
Evidence
The Evidence
Arrest after cardiac surgery is different — and survivable. Unlike arrest elsewhere in the hospital, many of these events have reversible causes: tamponade, bleeding, graft occlusion, pacing failure. The Society of Thoracic Surgeons recommends that all staff who care for these patients be trained in a cardiac-surgery-specific resuscitation protocol and rehearse it regularly. That protocol is CSU-ALS. Teaching it — well, repeatedly, and to the entire team — is what Essentials of Cardiac Surgical Resuscitation (ECSR) is for.
The ECSR approach rests on published guidelines and peer-reviewed outcomes research:
Dunning J et al, The Society of Thoracic Surgeons Expert Consensus for the Resuscitation of Patients Who Arrest After Cardiac Surgery. Ann Thorac Surg. 2017;103(3):1005–1020. Establishes CSU-ALS as the recommended standard and calls for regular team rehearsal.
Cardiac Surgery Unit Advanced Life Support Training: A 10-Year Retrospective Study Examining Patient Mortality Outcomes After Implementation. 2022. Ten years of mortality outcomes following CSU-ALS implementation.
Cardiac Surgical Unit–Advanced Life Support–certified centers are associated with improved failure to rescue after cardiac arrest: A propensity score–matched analysis. J Thorac Cardiovasc Surg. 2024. CSU-ALS-certified centers showed 70% lower risk-adjusted odds of failure to rescue across 12,209 propensity-matched patients at 15 institutions.
Multicenter data show that centers training with CSU-ALS achieve measurably lower Failure to Rescue after cardiac surgical arrest. CARE's Centers of Excellence contribute to ongoing research.
Who should train: bedside nurses, advanced practice providers (PA/NP), respiratory therapists, clinical pharmacists, perfusionists, surgical residents and fellows, attending surgeons, intensivists, anesthesiologists and nurse educators. Not every team member will fill every role in the protocol — but every team member needs to understand it. Widespread understanding of the CSU-ALS algorithm is what produces calm, coordinated responses when seconds matter.