The Society of Cardiovascular Anesthesiologists (SCA) was established in 1978 to provide education and to support research and mentorship to anesthesiologists caring for patients with cardiac disease undergoing cardiac and non-cardiac surgery. The Accreditation Council for Graduate Medical Education (ACGME) approved an SCA-sponsored application for fellowship training in adult cardiothoracic anesthesiology in 2006 and began accrediting cardiac anesthesiology fellowship training programs shortly thereafter. Interest in these training programs has been demonstrated within the San Francisco Match data, which reported a 32% increase in applications from 2013 (267) to 2018 (354). There are now 70 accredited programs with a capacity to train over 200 fellows each year. All 10 of the highest-ranked hospitals for cardiac care by US News & World Report have ACGME-accredited cardiothoracic anesthesiology fellowships.
The SCA received notification in June 2021 that the American Board of Medical Specialties (ABMS) had approved a new board certification for Cardiac Anesthesiology in response to an application from the American Board of Anesthesiology (ABA). The ABA’s application was based upon an SCA application to the ABA to recognize the evolution of the subspecialty over recent decades beyond the only existing certification in cardiac ultrasound. Specifically, Cardiac Anesthesiology board certification seeks to recognize clinical expertise beyond echocardiography, including the anesthetic management of complex cardiac physiology, anticoagulation, hypothermia, circulation, mechanical ventilation, cardiac arrhythmias, end-organ ischemia, bleeding, and the systemic response to extracorporeal circulation. Those practicing cardiac anesthesia have developed expertise to prevent, treat, and rescue patients from hemodynamic perturbations that are potentially life threatening as a consequence of their cardiac disease. Mechanical circulatory assistance for the treatment of heart failure has also evolved beyond the intra-aortic balloon pump and now includes percutaneous extracorporeal circulatory assistance, which in some centers is initiated and managed by cardiac anesthesiologists. Expertise has also developed in the perioperative management of cardiac patients beyond the OR to the critical care unit.
Regardless of formal ACGME-approved fellowship training, it is anticipated that a “practice experience pathway” to certification will be available for a limited time for those who trained before ACGME accreditation of fellowships and for those who have acquired expertise in clinical practice. It should be noted that the new board certification is for Cardiac Anesthesiology, and not Cardiothoracic Anesthesiology (as per the ACGME fellowship) nor Cardiovascular Anesthesiology (as per the SCA’s name). This will not obligate those practicing thoracic anesthesia and vascular anesthesia to obtain such subspecialty certification, as these areas are cared for by many anesthesiologists who have not had formal training beyond their general (core) anesthesiology residency training.
Perioperative echocardiography (PTE) is almost exclusively provided by cardiac anesthesiologists in 2021, and their expertise is recognized by the National Board of Echocardiography (NBE), which provides examinations and a certification process specifically for assessing knowledge and demonstrating expertise in echocardiography. The SCA has been providing its membership thorough didactic and simulation education in echocardiography through conferences and panel discussions at EchoWeek and our Annual Meeting since the inception of board certification in PTE. Similarly, the SCA will continue to provide education in cardiac anesthesia as it has for over 40 years. Anesthesiologists will be able to use this education for enhancing patient care, but now also for demonstrating their knowledge and expertise within this board certification. It is anticipated that the examination content will reflect current practice and the ACGME content outlined for fellowship programs. The SCA is committed to making sure its members will be fully prepared to demonstrate their expertise in the ABA’s new examination for Adult Cardiac Anesthesiology, which is anticipated to be first offered in 2023.
This is certainly an exciting time in the history of cardiac anesthesiology, built upon the work, insight, experience, and expertise of many who have come before us. The SCA is excited to share this news with the broader anesthesiology community and to encourage those who have gained such expertise, either through formal training or practice experience, to demonstrate to the public your qualifications in caring for patients undergoing cardiac surgery through this new board certification.