New AHA Statement on Preventing Cardiac ICU Complications

Megan Brooks

October 29, 2020

For patients in the cardiac intensive care unit (CICU), use of a bedside checklist on daily rounds could optimize care and help prevent infections and other common complications, the American Heart Association (AHA) says in a new scientific statement.

Christopher B. Fordyce

"CICUs have evolved to care for patients not only with primary cardiovascular conditions, but those with other complex medical issues," Christopher B. Fordyce MD, chair of the statement writing group, told theheart.org | Medscape Cardiology.

"While general ICUs have several guidelines in this arena, none existed in the CICU space that was specific to complex cardiac patients or their cardiovascular-trained providers," said Fordyce, director, Cardiac Intensive Care Unit, Vancouver General Hospital, British Columbia, Canada.

"This document highlights important complications and provides strategies to prevent them, and in doing so, provides a framework for CICUs that don't already have a system in place," he said.

The 28-page statement was published online October 29 in Circulation.

B est Practices in the CICU

The writing group evaluated strategies to avoid potentially preventable complications encountered in contemporary CICUs, focusing on those that are most applicable to this unique environment. They reviewed evidence-based practices derived in non-CICU populations and assessed their relevance to CICU care. The group used their findings to develop a checklist to encourage best practices to prevent common complications.

Hand hygiene is the cornerstone of infection prevention, and CICU staff should monitor for the presence of pathogens and ensure proper cleaning and stringent disinfection of equipment and the environment, the authors advise.

Key sources of potential infection include catheters, mechanical circulatory support, and ventilators, with the risk increasing the longer these devices are used. The group recommends using invasive devices for as short a time as possible to reduce the risk for associated infections.

When mechanical ventilation is required, noninvasive, positive-pressure ventilation should be considered when appropriate. The group recommends using tools to predict extubation success, including a daily trial of spontaneous breathing to identify patients who are ready to be taken off the ventilator.

It's also important to anticipate the need for invasive procedures and devices to avoid emergency procedures when possible, as rates of infections and other complications are higher in urgent procedures, the authors say.

They advise incorporating routine early mobilization protocols into CICU management plans to guard against ICU-acquired muscle weakness, which affects as many as one-third of critically ill CICU patients.

Incorporating the checklist into daily CICU rounds can also help minimize gastrointestinal complications, feeding complications, medication errors, and adverse drug events that are common in ICU settings, the authors note.

"Cardiac critical care is a growing field, and there is an urgent need to implement strategies to optimize care among patients admitted to the CICU," Fordyce said in a news release.

"These strategies can help CICU professionals anticipate and prevent complications in this unique patient population, and we encourage critical care teams to reflect upon their current practices and consider implementing these strategies where any gaps exist," he added.

The s cientific s tatement was developed by the writing group on behalf of the AHA Acute Cardiac Care and General Cardiology Committee of the Council on Clinical Cardiology; Council on Arteriosclerosis, Thrombosis and Vascular Biology; Council on Cardiovascular and Stroke Nursing; Council on Cardiopulmonary, Critical Care, Perioperative and Resuscitation; and the Stroke Council.

Circulation. Published online October 29, 2020. Full text

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