The complexity of some procedures may necessitate anaesthetic involvement in multidisciplinary team meetings and this activity should be reflected in job plans.
Consultant or autonomously practising anaesthetists in cardiac units should be responsible for the provision of service, teaching, protocol development, management, research and quality improvement. Adequate time should be allocated in job plans for these activities.
Each unit should have a designated clinical lead (see Glossary) anaesthetist who is responsible for cardiac anaesthesia services. This should be recognised in their job plan and they should be involved in multidisciplinary service planning and governance within the unit.
An appropriately trained consultant or autonomously practising cardiac anaesthetist should be wholly and exclusively available at all times, through a formal on-call rota.4 The out of hours duties of the on-call consultant or autonomously practising cardiac theatre anaesthetist should cover only cardiac emergencies, as they can arise and escalate very rapidly, particularly in tertiary referral units. On-call cardiac intensive...
Trained anaesthetic assistance, theatre staff and appropriate facilities should be immediately available for emergency resternotomy and cardiopulmonary bypass. A suitably trained resident anaesthetist should be immediately available for theatre emergencies and to assist the on-call consultant or autonomously practising cardiac anaesthetist in theatre out of hours.5
Appropriate local arrangements should be made for the care of postoperative surgical patients being managed outside the main cardiac intensive care unit (ICU), for example postoperative recovery areas and wards.6
Perfusion services should be provided by suitably trained and accredited clinical perfusion scientists and should comply with Department of Health guidelines. A suitable number of trained perfusionists should be always available according to the recommendations for standards of monitoring during cardiopulmonary bypass.7
Interventional cardiology services increasingly require anaesthesia, critical care, perfusion, operating department practitioners and nursing resources, depending on procedural complexity and patient morbidity. General anaesthesia is frequently needed to facilitate complex interventions or required in an emergency for invasive cardiological procedures. Both eventualities require that appropriate anaesthetic staffing, skilled assistance, equipment and monitoring should be available.2
At centres where 24/7 primary percutaneous coronary interventions are performed, and in designated heart attack centres that include out of hospital cardiac arrest patients, there should be provision for immediate availability of a resident anaesthetist, skilled assistance and appropriate equipment and facilities.
The same level of equipment should be available for cardiac surgery as is available in general theatres as specified in Chapter 3. Additional specialty-specific monitoring is required and is detailed below.9
