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首页> 外文期刊>International Journal of Heart Rhythm >Feasibility of an Elective Cardioversion Service Led by Advanced Practice Providers without Direct Cardiologist Supervision
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Feasibility of an Elective Cardioversion Service Led by Advanced Practice Providers without Direct Cardiologist Supervision

机译：由高级实践提供者提供的直接心脏复律服务的可行性，而无需直接心脏科医生的监督

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Background: Elective direct current cardioversion (DCCV) has traditionally been performed by physicians in the United States. A few recent reports from the United Kingdom suggested that a specialist nurse-led service for elective DCCV of persistent atrial fibrillation was feasible. This practice has not been reported in the United States previously. Several years ago, we introduced a program where specially trained advanced practice providers (APPs) (physician assistants and nurse practitioners) assisted by an anesthesiology team, performed elective DCCV in patients with atrial fibrillation and atrial flutter, without direct cardiologist supervision. Methods: Upon receiving approval from the Institutional Review Board, we conducted a retrospective analysis of 447 consecutive DCCVs electively performed by APPs, for atrial fibrillation or atrial flutter, at Regions Hospital between 12/2006 and 10/2010. Transient deep sedation was administered by an anesthesiology team. The cohort was evaluated for procedural success and safety. Results: The procedural success rate was 92% (412/447). The incidence of procedural related adverse events, requiring immediate intervention, was 0.2% (1/447). This patient required emergent temporary pacing catheter insertion followed by a permanent pacemaker implantation at a later date. There were no other procedure-related complications and no thromboembolic events. A comparison with fifty elective cardioversions performed by cardiologists during the same period found no statistical difference in procedural success rates or complications. Conclusion: Under deep sedation administered by anesthesiology service, elective DCCV of atrial fibrillation and atrial flutter performed by well-trained APPs, without direct cardiologist supervision, is feasible and does not compromise patient safety.
机译：背景技术：传统上，电调直流电复律（DCCV）是由美国的医生进行的。英国最近的一些报道表明，由护士主导的针对持续性房颤的选择性DCCV的服务是可行的。以前在美国没有这种做法的报道。几年前，我们引入了一个程序，其中由经过专门培训的高级实践提供者（APP）（医师助理和护士）在麻醉小组的协助下，对有房颤和房扑的患者进行选择性DCCV，而无需心脏病专家的直接监督。方法：在获得机构审查委员会的批准后，我们​​对12月2006年至10月10日之间在地区医院进行的447例由APP选择性执行的连续DCCV进行了回顾性分析，用于房颤或房扑。瞬态深层镇静由麻醉小组进行。对该队列进行了程序成功和安全性评估。结果：手术成功率为92％（412/447）。需要立即干预的与程序相关的不良事件发生率为0.2％（1/447）。该患者需要紧急起搏导管的临时插入，之后再进行永久性起搏器植入。没有其他与手术相关的并发症，也没有血栓栓塞事件。与同期由心脏科医师进行的五十次择期心脏复律的比较发现，手术成功率或并发症没有统计学差异。结论：在麻醉服务部门进行的深度镇静下，由训练有素的APP进行的心房纤颤和心室扑动的选择性DCCV，无需心脏病专家的直接监督，是可行的，并且不会损害患者的安全性。

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