See the published version of this article at BMC Cardiovascular Disorders.
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Research article
Procedural sedation for direct current cardioversion: a feasibility study between two management strategies in the emergency department.
Federico Guerra
Universita Politecnica delle Marche
Corresponding Author
ORCiD: https://orcid.org/0000-0001-5394-1312
License:
This work is licensed under a CC BY 4.0 License. Read Full License
View the published version at BMC Cardiovascular Disorders.
Background
A cardiologist-only approach to procedural sedation with midazolam in the setting of elective cardioversion (DCC) for AF has already been proven as safe as sedation with propofol and anaesthesiologist assistance. No data exist regarding the safety of such a strategy during emergency procedures. The aim of this study is to compare the feasibility of sedation with midazolam, administered by a cardiologist, to an anaesthesiologist-assisted protocol with propofol in emergency DCC.
Methods
Single centre, prospective, open blinded, randomized study including all consecutive patients admitted to the Emergency Department requiring urgent or emergency DCC. Patients were randomized in a 1:1 fashion to either propofol or midazolam treatment arm. Patients in the midazolam group were managed by the cardiologist only, while patients treated with propofol group underwent DCC with anaesthesiologist assistance.
Results
Sixty-nine patients were enrolled and split into two groups. Eighteen patients (26.1%) experienced peri-procedural adverse events (bradycardia, severe hypotension and severe hypoxia), which were similar between the two groups and all successfully managed by the cardiologist. No deaths, stroke or need for invasive ventilation were registered. Patients treated with propofol experienced a greater decrease in systolic and diastolic blood pressure when compared with those treated with midazolam.
Conclusions
Procedural sedation with midazolam given by the cardiologist alone was safe, well-tolerated and cost-effective in emergency DCC.
Keywords
Atrial fibrillation, cardioversion, emergency procedures, midazolam, propofol, sedation
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CURRENT STATUS: Published
Version 1
Posted 15 Jun, 2020
Published
On 25 Aug, 2020
No community comments so far
Review #2 received
Received 16 Jul, 2020
Reviewer #2 agreed
On 23 Jun, 2020
Reviewer #1 agreed
On 17 Jun, 2020
Review #1 received
Received 17 Jun, 2020
Reviewers invited
Invitations sent on 12 Jun, 2020
Editor assigned
On 29 May, 2020
Submission checks complete
On 28 May, 2020
Editor invited
On 28 May, 2020
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Subject Areas
Cardiac & Cardiovascular Systems
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This preprint is under consideration at BMC Cardiovascular Disorders. A preprint is a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research article
Procedural sedation for direct current cardioversion: a feasibility study between two management strategies in the emergency department.
Federico Guerra
Universita Politecnica delle Marche
Corresponding Author
ORCiD: https://orcid.org/0000-0001-5394-1312
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Published
Version 1
Posted 15 Jun, 2020
Published
On 25 Aug, 2020
No community comments so far
Review #2 received
Received 16 Jul, 2020
Reviewer #2 agreed
On 23 Jun, 2020
Reviewer #1 agreed
On 17 Jun, 2020
Review #1 received
Received 17 Jun, 2020
Reviewers invited
Invitations sent on 12 Jun, 2020
Editor assigned
On 29 May, 2020
Submission checks complete
On 28 May, 2020
Editor invited
On 28 May, 2020
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
Subject Areas
Cardiac & Cardiovascular Systems
License:
This work is licensed under a CC BY 4.0 License. Read Full License
View the published version at BMC Cardiovascular Disorders.
Background
A cardiologist-only approach to procedural sedation with midazolam in the setting of elective cardioversion (DCC) for AF has already been proven as safe as sedation with propofol and anaesthesiologist assistance. No data exist regarding the safety of such a strategy during emergency procedures. The aim of this study is to compare the feasibility of sedation with midazolam, administered by a cardiologist, to an anaesthesiologist-assisted protocol with propofol in emergency DCC.
Methods
Single centre, prospective, open blinded, randomized study including all consecutive patients admitted to the Emergency Department requiring urgent or emergency DCC. Patients were randomized in a 1:1 fashion to either propofol or midazolam treatment arm. Patients in the midazolam group were managed by the cardiologist only, while patients treated with propofol group underwent DCC with anaesthesiologist assistance.
Results
Sixty-nine patients were enrolled and split into two groups. Eighteen patients (26.1%) experienced peri-procedural adverse events (bradycardia, severe hypotension and severe hypoxia), which were similar between the two groups and all successfully managed by the cardiologist. No deaths, stroke or need for invasive ventilation were registered. Patients treated with propofol experienced a greater decrease in systolic and diastolic blood pressure when compared with those treated with midazolam.
Conclusions
Procedural sedation with midazolam given by the cardiologist alone was safe, well-tolerated and cost-effective in emergency DCC.
Figure 1
Figure 2
Figure 3