SCAI Updates Consensus Guidelines on CCL Best Practices

April 28, 2021—The Society for Cardiovascular Angiography and Interventions (SCAI) announced the release of an expert consensus statement providing guidance for contemporary cardiac catheterization lab (CCL) standards for cardiologists, catheterization lab directors, and hospital leadership.

The document, “SCAI Expert Consensus Update on Best Practices in the Cardiac Catheterization Laboratory” was presented at the SCAI 2021 Virtual Scientific Sessions with simultaneous publication by Srihari S. Naidu, MD, et al online in Catheterization and Cardiovascular Interventions. SCAI advised that the statement has been endorsed by the American College of Cardiology Clinical Policy Approval Committee, American Heart Association, and the Heart Rhythm Society.

Dr. Naidu, who chaired the writing committee, commented in SCAI’s announcement, “First released in 2012, then updated in 2016 and now 2021, the document highlights a patient-centric approach to procedures in the CCL, incorporating all the latest advances and standards.”

Dr. Naidu continued, “Dividing the logistics into the preprocedure, intraprocedure, and post-procedure periods, and including staffing, quality metrics, industry relations, and governance, the document should hopefully further serve as a contemporary look at the optimal running of these busy areas. We have also included areas where operators overlap, such as interventional cardiologists and electrophysiologists, for a more collegial collaborative spirit towards these complex patients and provided guidance on procedures performed in various settings including outpatient labs.”

Daniel Kolansky, MD, Vice-Chair of the writing committee and SCAI 2021 Program Chair, added, “This comprehensive statement, prepared by experts across a range of disciplines, builds on prior consensus statements and provides updates focused on current patient-centered and evidence-based approaches to care.”

Dr. Kolansky further stated, “The document covers topics ranging from pre-procedure assessment to intraprocedural best practices and safe discharge and follow-up needs of the patient. The document highlights regulatory and accreditation requirements for cath labs, a heart team approach to complex care, and discussion of what constitutes an optimal cath lab team. It also addresses collaboration between disciplines such as interventional cardiology and cardiac electrophysiology. This document will serve as a guide for lab directors, hospitals, and health systems in establishing current best practices for catheterization labs.”

As outlined in the SCAI press release, the 2021 recommendations include the following:

• Emphasis on practical recommendations to optimize quality & outcomes through best practices, registries, risk calculators, and vascular access (radial first, vascular ultrasound)
• Updated discussion of ambulatory surgery centers and settings without on-site surgery
• Expanded section on CCL governance, including dyad leadership, respective roles, culture-setting, industry relationships, and patient experience optimization
• Emphasis on the heart team for various patient subsets, and new recommendations for coordination and collaboration with electrophysiologists
• Updated preprocedure checklist and pre-percutaneous coronary intervention time out
• Updated discussion of staff qualifications, certification, and optimal CCL team
• Updated timing and discussion of history and physical examination, informed consent, and required blood work
• Updated infection control guidance, including use of personal protective equipment and hand antiseptic solutions
• Emphasis on same-day discharge for select patients, with discussion of long-term guideline-directed medical therapy and lifestyle modification, and bedside delivery of medications to improve adherence