Author: Chase Doyle
A retrospective chart review has found high-frequency jet ventilation (HFJV) to be a safe and effective means of ventilating patients in the cardiac catheterization lab. In the new study, only two of 123 patients had to convert to traditional methods of ventilation over a 13-month implementation period.
The transition to the catheterization lab was simple and staff satisfaction high, according to the study’s authors; however, investigators acknowledged that further research should be conducted to demonstrate long-term outcomes, risks and improvements.
“We found this to be a surprisingly effective and easy-to-manage means of ventilating patients,” said Reginald T. Bulkley, MD, an anesthesiologist at Southern Illinois University School of Medicine, in Springfield. “It should be noted, however, that this approach absolutely requires a total intravenous anesthetic because the volatile agents are incompatible with the ventilator itself. As most of our staff in the cardiac cath lab were unfamiliar with this technique, the processed [EEG] monitor really helped us to implement that program.”
|Table. High-Frequency Jet Ventilation Procedures Performed in the Cardiac Catheterization Lab|
|Atrial fibrillation ablation||83||67|
|Atrial fibrillation/flutter ablation||7||5|
|Atrial flutter ablation||2||1|
|Atrial tachycardia ablation||1||1|
|Ventricular tachycardia ablation||1||1|
|PVC, premature ventricular contraction|
Anesthetic management of HFJV in the cath lab at the institution consisted of preoperative assessment of the patient, standard monitors plus an arterial line, processed EEG and general endotracheal anesthesia without volatile agent during HFJV. The method was achieved with a Monsoon ventilator via a standard endotracheal tube, and investigators recorded the ventilation parameters during the HFJV time, Dr. Bulkley noted.
HFJV has been defined as “artificial ventilation of the lungs using sub-dead space tidal volumes using supra-physiological frequencies” (Acta Anaesthesiol Scand 2017;61:1066-1074), although gas exchange during this process is not entirely understood. Despite the lack of physiologic clarity, however, HFJV ventilates the patient and offers an improved hemodynamic profile by decreasing peak airway pressure, said Dr. Bulkley, who noted that the technique has been adapted for use in the cath lab to improve conditions for procedures, reduce procedure time, and improve effectiveness.
“Utilizing HFJV in the cath lab should improve conditions for procedures by decreasing lung motion due to reduction in lung volume variation, and thus decreases left atrium motion,” Dr. Bulkley said. “Quieting of the surgical field improves the contact of ablation catheters, enhancing effectiveness and decreasing procedure time.”
“We did not see a pattern regarding the patients who were unable to tolerate the procedure,” said Dr. Bulkley, who noted that both cases occurred well into the study period and were thus unlikely to be the result of operator error. “Other studies have shown anywhere from 3% to 8% of patients cannot tolerate HFJV for one reason or another.”
Although there are insufficient data to determine the relationship between HFJV procedures and cardiac patient outcomes, Dr. Bulkley and his colleagues will explore this association as they continue to enlarge the study. The researchers also may survey other institutions to assess the prevalence of HFJV for cardiac procedures.