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A dedicated ultrasound machine should be present in each cardiac theatre for the placement of vascular catheters.¹⁵

Cardiac anaesthesia and surgery are carried out under intensive physiological patient monitoring. Equipment used routinely for monitoring during cardiac surgery should be available. This includes invasive pressure monitoring for both systemic arterial, central venous and pulmonary artery pressures.^10,15

Transoesophageal echocardiography should be immediately available^.16,17

Patients with complex conditions may require additional monitoring, such as pulmonary arterial pressure monitoring and measurement of cardiac output.¹⁰ Facilities for on-bypass haemofiltration should be available, which may include cytokine haemadsorption filters in patients with higher inflammatory burden.

Noninvasive cerebral monitoring should include depth of anaesthesia monitors and cerebral near-infrared spectroscopy.¹⁰

Monitoring during cardiopulmonary bypass should conform to the standards recommended by the joint working group of the Society of Clinical Perfusion Scientists of Great Britain and Ireland, ACTACC, the Society for Cardiothoracic Surgery in Great Britain and Ireland, and the European Guidelines on Cardiopulmonary Bypass in Adult Cardiac Surgery.^7,18

ECMO services may be available for post cardiotomy following failure to wean from cardiopulmonary bypass or as a planned transition.

Equipment for temporary pacing, including external pacing pads and emergency defibrillation, must be available.

A designated cardiac step-down unit and cardiac ward should be considered.

Cardiac surgery should be performed in dedicated operating rooms. It is unlikely that an operating room will be kept available at all times for emergencies. Local arrangements for urgent and emergency patients should be in place.