ACC Council Perspective Looks at Best Practices in Cardiology-Oriented Sedation

Safe, streamlined guidance on procedural sedation in urgent or unscheduled cases may be helpful for cardiologists, according to a perspective from ACC's Electrophysiology, Interventional and Imaging Section Leadership Councils, published Sept. 9 in the Journal of the American College of Cardiology.

John D. Fisher, MD, FACC, immediate past chair of ACC's Electrophysiology Section, et al., compare the 2018 American Society of Anesthesiologists (ASA) guidelines for sedation and the 2019 American College of Emergency Physicians (ACEP) guidelines for sedation. The authors explain that the ASA guidelines focus mainly on scheduled procedures for nonanesthesiologists, whereas the ACEP guidelines focus on the nonanesthesiologist physicians – such as cardiologists – performing urgent or emergent procedures that require sedation.

While many of the recommendations made within the new ACEP guidelines are appropriate for cardiology, the authors note that there remain fundamental differences between trauma and other emergencies encountered in the emergency department and urgent cardiac procedures.

Due to the scarcity of evidence-based recommendations in both the ACEP and ASA guidelines, the authors suggest considering a cardiology-oriented consensus document, as well as the creation of a national registry for procedural sedation.

The authors note that cardiologists do not need to make a choice between the two guidelines, as both have served in providing an organized framework for procedural sedation by nonanesthesiologists. However, they add that for the "gray" or in-between cases, cardiologists must use professional judgment in deciding how to best proceed.

While more details and cardiac procedures need to be covered, the authors conclude that "together, the ASA and ACEP guidelines provide stepping-stones for the development of cardiology-oriented best practices statements."

Clinical Topics: Arrhythmias and Clinical EP, Implantable Devices, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias

Keywords: Emergencies, Emergency Service, Hospital, Registries, Electrophysiology

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