Nurse Led Sedation: The Clinical and Echocardiographic Outcomes of the 5-Year Emory Experience

Keegan, Patricia; Lisko, John; Kamioka, Norihiko; Maidman, Samuel D.; Binongo, José; Wei, Junhao; Vadlamudi, Ratna K.; Edwards, J. Kirk; Vatsa, Nishant; Maini, Aneel; Reginauld, Shawn; Gleason, Patrick; Stewart, James; Devireddy, Chandan; Block, Peter C.; Greenbaum, Adam; Guyton, Robert A.; Babaliaros, Vasilis

doi:10.1080/24748706.2020.1773591

Cited by 14 publications

(6 citation statements)

References 11 publications

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“…Imaging guided femoral access was performed in all cases for large bore sheaths as well as for transradial and transfemoral secondary access sites. Nurse led conscious sedation was preferentially used to conserve anesthesia resources 10 . Final determination of a patient's discharge pathway occurred on the day of the procedure and was made based on each patient's history, procedural outcome, and post‐procedural clinical status at the time of discharge by the attending physician as outlined in the protocol.…”

Section: Methodsmentioning

confidence: 99%

Safety of same‐day discharge after uncomplicated, minimalist transcatheter aortic valve replacement in the COVID‐19 era

Perdoncin

Greenbaum

Grubb

et al. 2020

Cathet Cardio Intervent

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Objectives We sought to evaluate the safety, efficacy and feasibility of same‐day discharge after uncomplicated, minimalist TAVR. Background At the start of the COVID‐19 pandemic, we created a same‐day discharge (SDD) pathway after conscious sedation, transfemoral (minimalist) TAVR to help minimize risk of viral transmission and conserve hospital resources. Studies support that next‐day discharge (NDD) for carefully selected patients following minimalist TAVR is safe and feasible. There is a paucity of data regarding the safety of SDD after TAVR. Methods In‐hospital and 30 day outcomes of consecutive patients meeting pre‐specified criteria for SDD after minimalist TAVR at our institution between March and July of 2020 were reviewed. Outcomes were compared to a NDD cohort from July 2018 through July 2020 that would have met SDD criteria. Primary endpoints were mortality, delayed pacemaker placement, stroke and cardiovascular readmission at 30 days. Results Twenty nine patients were discharged via the SDD pathway after TAVR. 128 prior NDD patients were identified who met all criteria for SDD. The STS scores were similar between the two groups (SDD 2.6% ±1.5 vs. NDD 2.3% ± 1.2). There were no deaths at 30 days in either group. There was no significant difference in delayed pacemaker placement (SDD 0% vs. NDD 0.8%, p > .99) or cardiovascular readmission (SDD 0% vs. NDD 5.5%, p = .35) at 30 days. Conclusions Same day discharge following uncomplicated, minimalist TAVR in selected patients appears to be safe, achieving similar 30 day outcomes as a cohort of next day discharge patients.

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Section: Methodsmentioning

confidence: 99%

Safety of same‐day discharge after uncomplicated, minimalist transcatheter aortic valve replacement in the COVID‐19 era

Perdoncin

Greenbaum

Grubb

et al. 2020

Cathet Cardio Intervent

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“…19 The use of a strategy of local anaesthesia with or without light procedural sedation is associated with improved haemodynamic stability, shorter procedure times, reduced risk of post-procedure delirium, and accelerated mobilization and reconditioning. 31 Given the on-going demands placed on anaesthesiology services to attend to the challenging care of unstable COVID-19 patients, it may be judicious to consider a model of physician-directed and nurse-administered local anaesthesia or conscious sedation 32 if important safety targets can be met (e.g. ability to convert to general anaesthesia within 5 min in the event of an emergency).…”

Section: The Imperative Of a Minimalist Approachmentioning

confidence: 99%

Facilitating transcatheter aortic valve implantation in the era of COVID-19: Recommendations for programmes

Lauck

Forman

Borregaard

et al. 2020

European Journal of Cardiovascular Nursing

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The COVID-19 pandemic continues to significantly impact the treatment of people living with aortic stenosis, and access to transcatheter aortic valve implantation. Transcatheter aortic valve implantation (TAVI) programmes require unique coordinated processes that are currently experiencing multiple disruptions and are guided by rapidly evolving protocols. We present a series of recommendations for TAVI programmes to adapt to the new demands, based on recent evidence and the international expertise of nurse leaders and collaborators in this field. Although recommended in most guidelines, the uptake of the role of the TAVI programme nurse is uneven across international regions. COVID-19 is further highlighting why a nurse-led central point of coordination and communication is a vital asset for patients and programmes. We propose an alternative streamlined evaluation pathway to minimize patients’ pre-procedure exposure to the hospital environment while ensuring appropriate treatment decision and shared decision-making. The competing demands created by COVID-19 require vigilant wait list management, with risk stratification, telephone surveillance and optimized triage and prioritization. A minimalist approach with close scrutiny of all parts of the procedure has become an imperative to avoid any complications and ensure patients’ accelerated recovery. Lastly, we outline a nurse-led protocol of rapid mobilization and reconditioning as an effective strategy to facilitate safe next-day discharge home. As the pandemic abates, TAVI programmes must facilitate access to care without compromising patient safety, enable hospitals to manage the competing demands created by COVID-19 and establish new processes to support patients living with valvular heart disease.

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“…Careful evaluation of individualized risks and benefits of the two methods (CS versus GA) by the heart team is essential. Common exclusion criteria for CS include: morbid obesity, severe chronic obstructive disease, high risk of coronary artery obstruction, and the need for certain alternative access [ 24 ].…”

Section: Procedural Detailsmentioning

confidence: 99%

Update on Minimalist TAVR Care Pathways: Approaches to Care in 2022

et al. 2022

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Purpose of Review This review summarizes current data supporting a minimalist TAVR approach and identifies the need for additional study to optimize TAVR care. The authors discuss future directions of the TAVR landscape and how this necessitates evolution of minimalist care pathways. Recent Findings Transcatheter aortic valve replacement (TAVR) has become a mainstay in the treatment of aortic stenosis since the initial procedure in 2002. Recently, attention has shifted to TAVR optimization and the minimalist approach with a focus on minimizing procedural sedation, protocolization of perioperative management, and prioritization on early discharge. This approach has been shown to be safe and reduce procedure time, length of stay, and overall cost for hospital systems. Summary The minimalist care pathway avoids general anesthesia, shortens procedure time and length of stay, and reduces cost without changing mortality or readmission rates at 30 days. A variety of protocols have been proposed without a clear consensus on specific components or patient eligibility. There is a continued need for data regarding patient risk stratification, valve selection, and discharge strategy as TAVR becomes increasingly common.

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Nurse Led Sedation: The Clinical and Echocardiographic Outcomes of the 5-Year Emory Experience

Cited by 14 publications

References 11 publications

Safety of same‐day discharge after uncomplicated, minimalist transcatheter aortic valve replacement in the COVID‐19 era

Safety of same‐day discharge after uncomplicated, minimalist transcatheter aortic valve replacement in the COVID‐19 era

Facilitating transcatheter aortic valve implantation in the era of COVID-19: Recommendations for programmes

Update on Minimalist TAVR Care Pathways: Approaches to Care in 2022

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