Congenital Cardiac Anaesthesia
Information for Healthcare Professionals
Introduction
Anaesthesia for patients with congenital heart disease is generally recognised to be a particular subspecialty area of expertise, and practitioners invariably obtain specialist training, in addition to their core anaesthetics training, should they wish to pursue a career in this subspecialty.
Congenital cardiac anaesthetists fall into three broad categories
Those with a pure paediatric anaesthetic practice
Those with a pure adult practice
Those who anaesthetise patients of all ages
Consultant appointees in any given Level 1 CHD Centre (L1 CHDC) are generally encouraged and supported to ensure they obtain all the necessary training – including fellowship(s) where appropriate - prior to consultant appointment. Fellowships may provide the opportunity to develop additional skills such as in transoesophageal echocardiography, mechanical support, transplantation, cardiac intensive care and so on.
There are eleven Level 1 NHS paediatric CHD Centres, of which the following have also have physically co-located adult cardiac surgery: Southampton, Bristol, Evelina, Brompton, Leeds, Newcastle. Although not physically co-located, Leicester provides Level 1 CHD services for both adults and children.
Congenital Cardiac Anaesthesia Network (CCAN)
The approximately eighty NHS paediatric cardiac anaesthetists are affiliated with the Congenital Cardiac Anaesthesia Network (CCAN). This is going through a process of increasing organisation with office holders (Dr Dan Taylor at Evelina Children’s Hospital is the current Chair of the group), an annual scientific meeting (usually held at the same time as the BCCA annual meeting) and some successful/ongoing research, publication and audit projects. Work is under way to create a website for CCAN. There is regular communication amongst the CCAN representatives for each paediatric Level 1 CHD Centre. We have built an affiliation with CCAS, our US counterpart organisation.
We are also looking at building and developing links amongst all the NHS congenital cardiac anaesthetists (ie those with both paediatric/adult/mixed practices) through the Association of Cardiothoracic Anaesthesia and Critical Care. Finally, many anaesthetists with a paediatric CHD anaesthetic practice are members of the Association of Paediatric Anaesthetists.
Education and Training
Fellowships in paediatric/ congenital cardiac anaesthesia are currently available at Great Ormond Street, Evelina, Leicester, Alder Hey and Newcastle. There are several recent papers looking at training in paediatric cardiac anaesthesia of which this is the most recent: Wilkinson K, Taylor D, Murphy T. Pediatric Cardiac Anaesthesia Training and Staffing in the National Health Service. Pediatr Anesth. 2023; 33: 1029-1033.
Key documents
Those with a CHD anaesthetic practice at a L1 CHD centres are regularly asked for advice and support regarding adult or paediatric patients with significant CHD undergoing non-cardiac surgery. Some CHD networks have specific advice regarding the importance of understanding the significance and relevance of CHD in the setting of anaesthesia for non-cardiac surgery. Examples are below:
Useful links
Association of Paediatric Anaesthetists https://www.apagbi.org.uk/
Association of Cardiothoracic Anaesthetists https://www.actacc.org/
Congenital Cardiac Anesthesia Society (USA) https://ccasociety.org/
Cardiothoracic Anaesthesia Partnership - Advanced Cardiothoracic Anaesthesia Education CAP (cardiothoracicanaesthesia.com)
Training in paediatric TOE https://doi.org/10.1111/pan.13572
Risks of TOE in children https://doi.org/10.4103%2Faca.aca_275_20
Updated: Dr Tim Murphy Nov 2024