RIsk Stratification prior to lead Extraction and impact on major intraprocedural complications (RISE protocol)

Autor: Ralph Augostini, Muhammad R. Afzal, Courtney Gilliam, S. Kalbfleisch, Charles J. Love, Emile G. Daoud, Jaret Tyler, Daniel Pinkhas, Raul Weiss, Nancy Matre, Juan A. Crestanello, John D. Hummel, Mahmoud Houmsse, Katja Turner, Toshimasa Okabe, Abigail B. Shoben, Melissa N. Burnside
Rok vydání: 2019
Předmět:
Male
medicine.medical_specialty
Pacemaker
Artificial
Time Factors
Databases
Factual
030204 cardiovascular system & hematology
Premises
Prosthesis Design
Risk Assessment
03 medical and health sciences
0302 clinical medicine
Postoperative Complications
Clinical Protocols
Risk Factors
Physiology (medical)
otorhinolaryngologic diseases
medicine
Humans
030212 general & internal medicine
Prospective Studies
Lead (electronics)
Coronary sinus
Device Removal
Aged
Ohio
Quality Indicators
Health Care
Retrospective Studies
Protocol (science)
Aged
80 and over
business.industry
Middle Aged
Quality Improvement
Defibrillators
Implantable
Treatment Outcome
Perfusionist
Cardiothoracic surgery
Emergency medicine
Risk stratification
Female
Cardiology and Cardiovascular Medicine
business
Hospitals
High-Volume
Lead extraction
Zdroj: Journal of cardiovascular electrophysiology. 30(11)
ISSN: 1540-8167
Popis: BACKGROUND An internal risk stratification algorithm was developed to decrease the risk of major adverse cardiac events (MACEs) during lead extractions (LEs). OBJECTIVE To report upon the impact of a risk stratification algorithm (RISE [RIsk Stratification prior to lead Extraction] protocol) on outcomes of LEs in a high-volume center. METHODS A retrospective review of a prospectively maintained LEs database was performed to identify features associated with MACEs. On the basis of the retrospective data, the RISE protocol differentiated LEs procedures into "High" and "Low" risk for occurrence of MACEs. High-risk LEs included dual-coil defibrillator lead (≥3 years), pacemaker and single-coil lead (≥5 years), and any StarFix coronary sinus lead. During the prospective evaluation of the RISE protocol, "High-risk" LEs were performed in an operating room (OR) or hybrid laboratory with the cardiac anesthesiologist, OR nursing team, perfusionist in the room, and a cardiac surgeon on the premises. "Low-risk" LEs were performed in the electrophysiology (EP) laboratory with anesthesia provided by EP nursing team. The preintervention (pre-RISE) and postintervention (post-RISE) group spanned 19 and 40 months and consisted of 449 (632 leads) and 751 patients (1055 leads), respectively. The primary outcome of MACEs in the two groups was compared. RESULTS Protocol compliance was 100%. The primary outcome of MACEs occurred in 15 patients (3.34%) before and 12 (1.6%) after implementation of the RISE protocol (P = .04). CONCLUSION RISE identified a low-risk group where minimal resources are needed and allowed for rapid intervention in the high-risk group that reduced the consequences of MACEs.
Databáze: OpenAIRE
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