Electrical cardioversion of atrial fibrillation or flutter with conscious sedation in the age of cost containment.

BACKGROUND: The purpose of this study was to compare the safety, efficacy, and cost of conscious sedation administered by electrophysiologists certified in the use of conscious sedation with sedation administered by anesthesiologists during cardioversion of atrial fibrillation or atrial flutter to sinus rhythm. METHODS AND RESULTS: Patients with hemodynamically stable persistent atrial fibrillation and flutter were included in this study. Group 1 patients (n = 33) were sedated by an anesthesiologist and group 2 patients (n = 26) were sedated by an electrophysiologist. Anesthesiologists used propofol and electrophysiologists used midazolam and morphine for sedation. A cost analysis based on professional charges and cost of medications was performed for both groups and compared. Hospital charges were similar for both groups and were excluded from the cost analysis. Although time to sedation in group 1 was shorter than that in group 2, sedation was adequate in both groups such that no patient in group 1 and only 1 patient in group 2 recalled being shocked. There were no complications in either group. The cost incurred in group 2 was less than that in group 1. CONCLUSIONS: Sedation administered by electrophysiologists for cardioversion of atrial arrhythmias is safe and cost effective. Midazolam and morphine, the sedative agents administered by electrophysiologists, were effective and well tolerated by patients.

A comparison of active compression-decompression cardiopulmonary resuscitation with standard cardiopulmonary resuscitation for cardiac arrests occurring in the hospital.

BACKGROUND: Recent studies have demonstrated improved cardiopulmonary circulation during cardiac arrest with the use of a hand-held suction device (Ambu CardioPump) to perform active compression-decompression cardiopulmonary resuscitation (CPR). The purpose of this study was to compare active compression-decompression with standard CPR during cardiac arrests in hospitalized patients. METHODS: All patients over the age of 18 years who had a witnessed cardiac arrest while hospitalized at our center were enrolled in this trial; they were randomly assigned according to their medical-record numbers to receive either active compression-decompression or standard CPR. The study end points were the rates of initial resuscitation, survival at 24 hours, hospital discharge, and neurologic outcome. Compressions were performed according to the recommendations of the American Heart Association (80 to 100 compressions per minute; depth of compression, 3.8 to 5.1 cm [1.5 to 2 in.]; and 50 percent of the cycle spent in compression). RESULTS: Sixty-two patients (45 men and 17 women) with a mean age (+/- SE) of 68 +/- 2 years were entered into the trial. Sixty-two percent of the patients who underwent active compression-decompression were initially resuscitated, as compared with 30 percent of the patients who received standard CPR (P < 0.03); 45 percent of the patients who underwent active compression-decompression survived for at least 24 hours, as compared with 9 percent of patients who underwent standard CPR (P < 0.004). Two of the 62 study patients survived to hospital discharge; both were randomly assigned to receive active compression-decompression. Neurologic outcome, as measured by the Glasgow coma score, was better with active compression-decompression (8.0 +/- 1.3) than with standard CPR (3.5 +/- 0.3; P < 0.02). CONCLUSIONS: In this preliminary study, we found that, as compared with standard CPR, active compression-decompression CPR improved the rate of initial resuscitation, survival at 24 hours, and neurologic outcome after in-hospital cardiac arrest. Larger trials will be required to assess the potential benefit in terms of long-term survival.