Every year an estimated 184,000 to 400,000 Americans die from sudden cardiovascular death due to left ventricular (LV) systolic dysfunction (Cesario & William Dec, 2006). One of the treatments of choice for the patient with a life-threating ventricular tachyarrhythmia is the automated implantable cardioverter defibrillator (AICD). Studies have shown that the placement of an automated implantable cardioverter defibrillator (AICD) in patients with LV systolic dysfunction significantly reduces overall mortality (Cesario & William Dec, 2006; Henyan et al., 2006).
Background and Significance
Over the past 20 years the AICD have become more complex due to technological advances and software sophistication. Today, the indication for implantation of the AICD is rapidly expanding (Schoenfeld, 2007). The use of these devices in managing a diverse population of cardiac patients is increasing. The National ICD Registry annual report for 2008 noted that the average age of patients receiving the device was 65 years old and more than 75% of the patients have 1 or more comorbid diseases (Kaufman, R. S., Mueller, S. P., Ottenberg, L. A. & Koening. A. B., 2011; Zhan, C., Baine, B. W., Sedrakyan, A., & Steiner, C., 2007). These factors contribute to the increasing numbers of patients with AICD devices in the United States. In 2008, 339,076 Americans received the device, compared to 75,000 implantations in 2001 and 34,000 in 2000 (Kaufman et al., 2011). The implication for the increasing number of patients with AICDs is that anesthesia providers will be more likely to encounter this patient population presenting for elective or emergency surgical procedures. While it is the anesthesia provider’s duty to provide safe and competent care, there are currently no set standards to guide the practice of the anesthetist in caring for the patients presenting to the operating room with an AICD. Therefore, the purpose of this project is to investigate the best evidence in managing the care of patients with AICDs undergoing surgical procedures.
An evidence-based approach to formulating a clinical question in a structured, specific way, is the PICO format. The PICO components (Patient/population, Intervention, Comparison intervention, and Outcome) were used to assist in the articulation of the research question for he project (Melnyk & Fineout-Overholt, 2005). The population of interest (P) for the project included surgical patients with an AICD. The intervention of interest (I) was perioperative management principles, which did not include a comparison (C) intervention. The outcome (O) of interest for the project was to evaluate the rates of delay or cancellation of surgery and perioperative device malfunction. The resulting clinical question in PICO format is as follows: “In patients with AICDs, what are the safest and most effective management principles that should be followed by the anesthesia provider in order to decrease...