SCAI/CCAS/SPA expert consensus statement for anesthesia and sedation practice: Recommendations for patients undergoing diagnostic and therapeutic procedures in the pediatric and congenital cardiac catheterization laboratory

Abstract

Current practice of sedation and anesthesia for patients undergoing pediatric congenital cardiac catheterization laboratory (PCCCL) procedures is known to vary among institutions, a multi-society expert panel with representatives from the Congenital Heart Disease Council of the Society for Cardiovascular Angiography and Interventions (SCAI), the Society for Pediatric Anesthesia (SPA) and the Congenital Cardiac Anesthesia Society (CCAS) was convened to evaluate the types of sedation and personnel necessary for procedures performed in the PCCCL. The goal of this panel was to provide practitioners and institutions performing these procedures with guidance consistent with national standards and to provide clinicians and institutions with consensus-based recommendations and the supporting references to encourage their application in quality improvement programs. Recommendations can neither encompass all clinical circumstances nor replace the judgment of individual clinicians in the management of each patient. The science of medicine is rooted in evidence, and the art of medicine is based on the application of this evidence to the individual patient. This expert consensus statement has adhered to these principles for optimal management of patients requiring sedation and anesthesia. What follows are recommendations for patient monitoring in the PCCCL regardless of whether minimal or no sedation is being used or general anesthesia is being provided by an anesthesiologist. © 2016 Wiley Periodicals Inc.

Anesthesia for high‐risk procedures in the catheterization laboratory

“…Younger age, higher ASA status, emergency procedures have been reported as risk factors for cardiac arrest during pediatric procedures . A recent expert consensus statement recommended that anesthesiologists with advanced skills and understanding of the pathophysiology and expertise in management of patients with CHD provide care for high‐risk patients …”

Simulation for Safety in the Pediatric Cardiac Catheterization Laboratory

“…Further, there is variation in the frequency of different procedures between centers and practitioners, and a wide variety of adverse outcomes can occur in different interventions. 2 In 2007, eight pediatric cardiac centers in the United States started a collaborative project called Congenital Cardiac Catheterization Project on Outcomes (C3PO), in which procedure and patient specific data are collected and compared across these eight centres. 3,4 One of the primary goals of this data was risk stratification according to procedure complexity.…”

“…The assignment of registered nurse or physician anesthesiologist is thus decided, based on the 10-component scoring system, the Catheterization Risk Score in Pediatrics (CRISP) score. 2 This tries to ensure that the assigned sedation provider understands the complex pathophysiology of congenital heart disease and is prepared for the anticipated adverse events associated with the procedure. Odegard et al from Children's Hospital Boston cardiac anesthesia team had published a significant reduction in cardiac arrests in catheterization laboratory after having changed their resource allocation and communication protocol.…”

The 2017 Seventh World Congress of Pediatric Cardiology & Cardiac Surgery: week in review: congenital cardiac anaesthesia

“…The recent consensus statement for anaesthesia and sedation practice for patients undergoing diagnostic and therapeutic procedures in the cardiac catheterisation laboratory from the Society for Cardiovascular Angiography and Interventions, Society for Pediatric Anesthesia, and the CCAS was brought up during the discussion. 3 The goal of this statement is to provide practitioners and institutions performing these procedures with guidance consistent with national standards and to provide clinicians and institutions with consensusbased recommendations. The recommendations include patient monitoring in the cardiac catheterisation laboratory, regardless of whether minimal or no sedation is being used, or general anaesthesia is being provided by an anaesthesiologist.…”

“…This session was popular with cardiologists who provide sedation during cardiac catheterisation or other procedures. The recent consensus statement for anaesthesia and sedation practice for patients undergoing diagnostic and therapeutic procedures in the cardiac catheterisation laboratory from the Society for Cardiovascular Angiography and Interventions, Society for Pediatric Anesthesia, and the CCAS was brought up during the discussion 3 . The goal of this statement is to provide practitioners and institutions performing these procedures with guidance consistent with national standards and to provide clinicians and institutions with consensus-based recommendations.…”