Procedural sedation for direct current cardioversion: a feasibility study between two management strategies in the emerg
- PDF / 728,287 Bytes
- 8 Pages / 595.276 x 790.866 pts Page_size
- 34 Downloads / 197 Views
(2020) 20:388
RESEARCH ARTICLE
Open Access
Procedural sedation for direct current cardioversion: a feasibility study between two management strategies in the emergency department Giulia Stronati1, Alessandro Capucci1, Antonio Dello Russo1, Erica Adrario2, Andrea Carsetti2, Michela Casella1, Abele Donati2 and Federico Guerra1*
Abstract Background: A cardiologist-only approach to procedural sedation with midazolam in the setting of elective cardioversion (DCC) for AF has already been proven as safe as sedation with propofol and anaesthesiologist assistance. No data exist regarding the safety of such a strategy during emergency procedures. The aim of this study is to compare the feasibility of sedation with midazolam, administered by a cardiologist, to an anaesthesiologist-assisted protocol with propofol in emergency DCC. Methods: Single centre, prospective, open blinded, randomized study including all consecutive patients admitted to the Emergency Department requiring urgent or emergency DCC. Patients were randomized in a 1:1 fashion to either propofol or midazolam treatment arm. Patients in the midazolam group were managed by the cardiologist only, while patients treated with propofol group underwent DCC with anaesthesiologist assistance. Results: Sixty-nine patients were enrolled and split into two groups. Eighteen patients (26.1%) experienced periprocedural adverse events (bradycardia, severe hypotension and severe hypoxia), which were similar between the two groups and all successfully managed by the cardiologist. No deaths, stroke or need for invasive ventilation were registered. Patients treated with propofol experienced a greater decrease in systolic and diastolic blood pressure when compared with those treated with midazolam. As the procedure was shorter when midazolam was used, the median cost of urgent/emergency DCC with midazolam was estimated to be 129.0 € (1st-3rd quartiles 114.6–151.6) and 195.6 € (1st-3rd quartiles 147.3–726.7) with propofol (p < .001). Conclusions: Procedural sedation with midazolam given by the cardiologist alone was feasible, well-tolerated and cost-effective in emergency DCC. Keywords: Atrial fibrillation, Cardioversion, Emergency procedures, Midazolam, Propofol, Sedation
* Correspondence: [email protected] 1 Cardiology and Arrhythmology Clinic, Marche Polytechnic University, University Hospital “Ospedali Riuniti Umberto I - Lancisi - Salesi”, Via Conca 71, Ancona, Italy Full list of author information is available at the end of the article © The Author(s). 2020 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the
Data Loading...
