Ahluwalia Nikhil, Bhattacharyya Sanjeev, Munns Christopher, Chambers John
Department of Echocardiography, Guy's & St Thomas' NHS Foundation Trust, London, UK.
Barts' Heart Centre, St Bartholomew's Hospital, London, UK.
Echo Res Pract. 2016 Mar;3(1):1-3. doi: 10.1530/ERP-15-0039. Epub 2016 Jan 19.
Transoesophageal echocardiography (TOE) can be used to expedite DC cardioversion (DCCV) in the absence of adequate anticoagulation. There are no guidelines for the management of sedation or general anaesthetic. We performed a survey of NHS echocardiography departments to determine UK practice. Responses were received from 95 (50%) of 189 centres, and TOE-guided DCCV was performed in 81 centres. The numbers were <10 a year in 41 (50%), 10 - 50 in 31 (38%), 50 - 100 in 8 (10%) and >100 in 4 (5%) centres. Sedation for TOE was a usual practice in 67 (80%) centres but often temporally disconnected from DCCV due to logistical reasons. TOE under general anaesthetic was performed in 35 (43%) centres and as the usual method in 16 (20%). The patient was in the supine position with endotracheal intubation in 20 (57%) of centres, but without any form of airway protection while supine in 5 (14%). There is variability in practice across centres in the UK, in part due to limitations to services in most centres but also because of an absence of UK guidelines. The development of national standards may address this and aid in the development of local business cases to extend services.
在未进行充分抗凝的情况下，经食管超声心动图（TOE）可用于加快直流电复律（DCCV）。目前尚无关于镇静或全身麻醉管理的指南。我们对英国国家医疗服务体系（NHS）的超声心动图科室进行了一项调查，以确定英国的实际做法。189个中心中有95个（50%）回复了调查，81个中心进行了TOE引导下的DCCV。各中心每年进行的例数情况为：41个（50%）中心少于10例，31个（38%）中心为10 - 50例，8个（10%）中心为50 - 100例，4个（5%）中心多于100例。67个（80%）中心通常对TOE进行镇静，但由于后勤原因，镇静往往与DCCV在时间上不衔接。35个（43%）中心在全身麻醉下进行TOE，其中16个（20%）中心将其作为常规方法。20个（57%）中心让患者仰卧并进行气管插管，但5个（14%）中心在患者仰卧时未采取任何形式的气道保护措施。英国各中心的实际做法存在差异，部分原因是大多数中心的服务存在限制，也因为缺乏英国的相关指南。制定国家标准可能会解决这一问题，并有助于制定地方商业案例以扩展服务。
