Cardiology Cath Labs

  • We have 3 coronary catheterisation labs ( labs B,A and D). Lab D ( closer to the nurses station in the HAC ward) is currently closed and undergoing refurbishment. Lab B ( closer to the corridor) is the lab used primarily for emergencies and major interventional procedures like TAVI's
  • We also have two Electrophysiology labs ( Labs 1 & 2).
  • Although lab B is the main lab for primary PCI's they could be done in any of the labs ( except the EP ones ) depending on the availability.
  • There are 2 anaesthetic machines for the 3 coronay labs.The default is that an anaesthetic machine should always be available and checked and ready to be used in the lab B.

Common Emergencies that need anaesthesia support

  1. Out of hospital cardiac arrest post ROSC/low GCS being brought in for coronary intervention ( because of ecg changes). The patient might have been intubated by paramedics or they may have inserted a LMA.Your help will be sought to secure definitive airway, help with vascular access and resuscitation, vaso-active drug administration and provide immediate critical care and safe transfer to GICU as required.
  2. Patient brought in with ECG changes, cardiogenic shock, hypoperfusion, confusion and agitation.Your help will be sought to manage airway and sedation /GA to facilitate primary PCI / resuscitation.
  3. Cardiac arrest/ peri-arrest situation developing in the middle of a PCI ( primary or elective)
  4. To rescue a failed sedation attempt by cardiologists ( respiratory depression / disinhibited, agitated patient etc.)
  5. Anaesthetic support for emergency arrhythmia/pacing service - patient often transported-in with anaesthetic escort from other hospitals. If they are returning to base hospital - keep the team : if going to our GICU afterwards - let the team go.

Of course this is not an exhaustive list.The crucial thing for improving patient outcome and team morale in this situation is communication between the team members and it is a two way process. The cardiologists are expected to give us adequate background information and a plan on your arrival.It will be good idea for the anaesthetic trainees to observe some of the elective PCI's to get an idea about what they do.There is some time pressure in these situations because there are some local and national targets to be met ( 'call to intervention' times) based on a 'time is muscle' concept. But a 'safety first' approach is always recommended.

Often the environment for the anaesthetists is less than ideal ( e.g C-arm in the way ,availability of trained assistance, NO tilting table/trolley etc.) compared to the operating theatres and we would suggest that you familiarise yourself to the environment as much as possible when it is quiet.

Cardiologists ( when requested) can help with ABG sampling, getting central venous and arterial access etc.