Author + information
- Received June 26, 2019
- Revision received July 23, 2019
- Accepted July 23, 2019
- Published online September 9, 2019.
- John D. Fisher, MDa,∗ (, )@JohnFisherDoc,
- Frederick G. Welt, MDb@FrederickWelt,
- Todd C. Villines, MDc,
- Alexander G. Truesdell, MDd@agtruesdell,
- Michael N. Young, MDe,
- Dhanunjaya Lakkireddy, MDf,
- Byron K. Lee, MDg,
- on Behalf of the ACC’s Electrophysiology Section Leadership Council,
- ACC’s Interventional Section Leadership Council,
- ACC’s Imaging Section Leadership Council
- aMontefiore Medical Center-Albert Einstein College of Medicine, Bronx, New York
- bUniversity Hospital, University of Utah School of Medicine, Salt Lake City, Utah
- cUniversity of Virginia Health System, University of Virginia School of Medicine, Charlottesville, Virginia
- dVirginia Heart/INOVA Heart & Vascular Institute, Falls Church, Virginia
- eDartmouth-Hitchcock Medical Center, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
- fHCA Midwest Health, Overland Park, Kansas
- gUniversity of California, San Francisco, San Francisco, California
- ↵∗Address for correspondence:
Dr. John D. Fisher, Cardiology Division F2, Montefiore Medical Center, 111 East 210th Street, Bronx, New York 10467.
• Safe, streamlined sedation guidance in urgent or emergent or unscheduled cases are needed.
• Traditional guidelines emphasize scheduled procedures; new emergency medicine guidelines are helpful but cover only some cardiology indications.
• Our councils make suggestions for developing sound practices for cardiology-oriented urgent procedural sedation.
Until 2019, guidelines for procedural sedation emphasized a detailed process most applicable for elective procedures scheduled well in advance. These guidelines provided by the American Society of Anesthesiologists were adopted by many specialties and institutions, and they have historically served the medical field well. However, cardiologists and other specialists often encounter urgent situations that demand unscheduled sedation. Physicians have been concerned about performing procedures in a fashion that “departs from the guidelines.” In response, the American College of Emergency Physicians (ACEP) has developed a set of guidelines for patients requiring urgent unscheduled sedation. Many of the recommendations made within the novel ACEP guidelines are appropriate for cardiology, but there remain fundamental differences between trauma and other emergencies encountered in the emergency department and urgent cardiac procedures. This paper examines the differences between the American Society of Anesthesiologists and ACEP guidelines and provides some points to consider regarding best practices for cardiologists.
The views expressed in this paper by the American College of Cardiology's (ACC's) Electrophysiology Section Leadership Council, the ACC’s Interventional Section Leadership Council, and the ACC’s Imaging Section Leadership Council do not necessarily reflect the views of the Journal of the American College of Cardiology nor the ACC.
Dr. Truesdell has served as a consultant to and on the Speakers Bureau for Abiomed. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
Listen to this manuscript's audio summary by Editor-in-Chief Dr. Valentin Fuster on JACC.org.
- Received June 26, 2019.
- Revision received July 23, 2019.
- Accepted July 23, 2019.
- 2019 American College of Cardiology Foundation
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