Key result
A UK survey of 107 hospitals found that 86% of cardioversions were performed in theatre or critical care, with 79.5% administered by a consultant anaesthetist, though only 14% had written protocols.
Cross-Sectional (n=107)
Yes
A UK survey demonstrates that anaesthesia for cardioversion is generally performed by consultant anaesthetists in appropriate settings with high standards of equipment, though written protocols and audits are lacking.
Answers are grounded in this paper and cite their sources.
Current UK practice shows high standards without protocols; leaves open whether written protocols would enhance consistency or safety.
We conducted a postal survey of anaesthetic departments which enquired about anaesthetic practice for cardioversion. A questionnaire was sent to consultant anaesthetists at 150 randomly selected hospitals throughout the UK. Questions were designed to establish basic data about the site and timing of the procedure and the personnel, drugs and equipment available. Of the questionnaires sent, 107 (71.3%) were returned. The results showed that 86% of cardioversions were performed either in theatre or a critical care area. A consultant anaesthetist provided anaesthesia in 79.5% of cases whilst less than 5% were administered by an SHO. This can be compared to the 46% and 18.5% of cardioversions performed by consultant physicians and SHO's, respectively. Anaesthesia for cardioversion was provided by on-call staff in 53% of cases whilst 40% were done during a specifically allocated session. Ninety-eight percent of cardioversions were done during normal working hours and skilled anaesthetic assistance was available for 86% of cases. Recent electrolyte and coagulation results were available in 79% and 69% of cases, respectively. Adequate emergency airway equipment, suction and drugs were available for 90% of cardioversions, whilst full monitoring was available in 85%, and an anaesthetic machine was used in 69% of cases. Propofol was the anaesthetic agent of choice in 90% of hospitals whilst 9% used etomidate; 43% of departments used short-acting opiates to provide analgesia during cardioversion. A written protocol for anaesthesia for cardioversion existed in 14% of anaesthetic departments, but only 7% actively audited their results. The Royal College of Anaesthetists has published recommendations regarding the safe conduct of anaesthesia for cardioversion [1]. Concerns have been expressed that cardioversion is often performed out of hours, in remote sites, by inexperienced anaesthetists, with suboptimal assistance and equipment [2]. The results of our survey show that, in general, the standards of equipment and staffing are high with the vast majority of cardioversions being performed by consultant anaesthetists in an appropriate setting during normal working hours. However, few departments have written protocols for, or actively audit the results of cardioversion.
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James et al. (2003) conducted a cross-sectional in Anaesthesia for cardioversion (n=107). Anaesthetic practice for cardioversion was evaluated on Survey responses regarding site, timing, personnel, drugs, and equipment for cardioversion anaesthesia. A UK survey of 107 hospitals found that 86% of cardioversions were performed in theatre or critical care, with 79.5% administered by a consultant anaesthetist, though only 14% had written protocols.
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