High Stakes, High-Fidelity Simulation: Improving Patient Outcomes During Malignant Hyperthermia Crises

Malignant hyperthermia (MH) is a rare, life-threatening disorder triggered by certain anesthetic agents. Prompt recognition and intervention are critical to prevent morbidity and mortality. For unique cases such as MH, many nurse anesthesia programs use high-fidelity simulation to prepare resident registered nurse anesthetists (RRNAs) for low-frequency high-stakes events. This case report highlights a RRNA who participated in a high-fidelity MH simulation prior to graduation, which provided a valuable opportunity to identify and improve technical and nontechnical skills. Three months post-graduation, the novice Certified Registered Nurse Anesthetist (CRNA) encountered a real MH event in a 38-year-old female undergoing general anesthesia post cesarean section. Drawing on the prior simulation experience, the CRNA promptly recognized the signs and initiated the MH protocol. The patient was successfully discharged a few days after the event and reunited with her infant. This case highlights the impact of simulation-based education on patient care. High-fidelity simulation fosters clinical readiness, enhances decision-making, and can directly contribute to improved patient outcomes. Nurse anesthesia programs should also consider integration of virtual reality to promote repeated exposure of these low frequency, high-stakes events.