The impact of the introduction of monitored anaesthesia care in the cardiac catheterisation laboratory on Clinical Review,Rapid Response,and Blue Code rates,and mortality

Abstract

Most procedures in cardiac catheterisation laboratories (CCLs) have traditionally been performed under conscious sedation under the supervision of the treating proceduralist. With growing demand for more complex procedures to be performed, in emergencies and in patients with limited cardiorespiratory reserve, a reconsideration of the level of supervision provided is required. We conducted a retrospective cohort study of all patients who had CCL procedures and required an overnight stay at Royal North Shore Hospital during a 12-month period prior to introducing monitored anaesthesia care (MAC), compared with a 12-month period following introduction of MAC on selected weekdays. Primary outcomes were the difference in rates of Code Blue calls (triggering the cardiac arrest team), Clinical Reviews and Rapid Responses (defined as per the NSW Health ‘Between the Flags’ Deteriorating Patient Safety Net System) in the 24 h post-procedure between patients who did and did not have MAC. The secondary outcome was a difference in mortality (within 24 h of a procedure and in-hospital) between patients who did and did not have MAC. One thousand nine hundred and eight patients were analysed (926 pre-intervention, 982 post-intervention). We found no statistically significant difference in any of the primary or secondary outcomes between the pre-intervention and post-intervention patients overall. However, we found a statistically significant lower rate of Code Blue calls in patients who had MAC (n = 3, 0.6%) compared with no MAC (n = 31, 2.3%). We also found a significantly lower 24-h mortality in patients who had MAC (n = 1, 0.2%) compared with no MAC (n = 22, 1.6%), but no difference in overall in-hospital mortality.