A subgroup of patients with chronic thromboembolic pulmonary hypertension (CTEPH) will benefit from surgery and thise condition should be managed in designated national centres. Currently only one UK centre provides specialist surgical intervention for patients with CTEPH.
The use of ECMO for adult patients with severe respiratory failure is commissioned by the NHS in a small number of specialist centres. The use of ECMO for adult patients with cardiovascular collapse is currently commissioned by the NHS mainly in cardiothoracic transplant centres as a bridge to transplant. An increasing number of non-transplant cardiothoracic and heart attack centres are...
Anaesthetists should be aware of the risks of exposure to ionising radiation in cardiac catheterisation laboratories and should ensure that they use protective garments and screens and wear exposure monitoring devices if requested to do so.46
The use of dedicated anaesthetic monitoring equipment, in addition to any monitoring used by cardiologists, is recommended. A remote or slave anaesthetic monitor display should be available to cardiologists.
Cardiac patients are often at high risk of cardiac arrest. Sufficient space and facilities should be available for managing this eventuality. Transoesophageal echocardiography should be immediately available.
Cardiovascular instability may, on occasion, necessitate the use of extracorporeal support, including cardiopulmonary bypass. Catheter laboratories should have sufficient space, medical gas outlets, electrical sockets, network sockets and other essential facilities to meet this demand.
Where revision of rhythm management devices is considered to pose a high risk of requiring emergency surgical intervention, cardiopulmonary bypass equipment and a plan for surgery should be available at the start of the procedure.47
Cardiac anaesthesia is a ‘key unit of training’ for stage 2 training in anaesthesia.42 Trainee anaesthetists should be of appropriate seniority to be able to benefit from this area of training.
All anaesthetists in training should be appropriately clinically supervised at all times.52
Trainees should have an appropriate balance between cardiac and ICU training based on their individual requirements.
