Cardiac Cath Lab – Catheterization Lab Cardiac arrest is rare and uncommon. This makes it difficult to plan for. It can have dire consequences, especially for patients with serious pre-existing diseases (high-risk patient), such as acute cardiac infarction with cardiogenic shocked or patients undergoing high-risk procedures. Cardiac arrest in the cath lab is becoming more common as more complex procedures are performed to bring patient back in healthy condition. This situation must be managed well for both the patient, and the operator.
Introduction to Cardiac Cath Lab
It is rare to experience cardiac arrest in the catheterization laboratory (cath Lab), but it can sometimes lead to serious complications. This is most common in patients with severe pre-existing diseases (high-risk patient), or in patients who are undergoing higher-risk procedures. When a complication occurs, such as an acute vessel closure or coronary stenosis, the incidence is significantly higher.
The mortality rate for Cardiac Cath Lab was historically low (0.1% for all comers). The rapid development of percutaneous coronary techniques and hemodynamic support devices has allowed for many high-risk patients to be offered PCI (percutaneous cardiac intervention). Their mortality rate is higher (>30% in those who have sustained cardiogenic shock. The number of high-risk procedures in the Cardiac Cath Lab has increased significantly over recent years due to the proliferation of heart disease interventions such as percutaneous transaortic (TAVR) and mitral valve repairs. In the PARTNER study, 8% of patients undergoing TAVR had to receive emergent mechanical circulatory support due to hemodynamical instability. 4.3% of patients experienced cardiac arrest in a recent TAVR-series.
A cath lab can cause cardiac arrest. This is an unusual situation. The precipitating factor for cardiac arrest in the cath lab is rare. A failed resuscitation attempt for in-hospital or out-ofhospital cardiac arrest is usually accepted. However, cardiac arrest during a Cardiac Cath Lab laboratory procedure is considered a serious complication. This creates a lot of pressure for the team. Therefore, heroic resuscitation is common. This event has two major goals: maintain vital organ perfusion, and reverse the precipitating causes.
Cath Lab Environment for Cardiac Arrest
The cardiac cath lab has certain advantages for cardiac arrest. The patient is continuously monitored for arterial pressure and ECG to ensure that the event is quickly identified. Pre-connected defibrillation pad are often available so that time for the procedure can be reduced.
Continuous arterial pressure can also be used to provide immediate feedback on chest compression quality. You have a variety of support equipment, such as hemodynamic support devices, cardiac medications, and pericardiocentesis Kit . This equipment can also be used to treat cardiac emergencies. The Cardiac Cath Lab staff and cardiologists are well-trained.
Special challenges are also presented by the cath lab environment, especially with traditional manual chest compressions. High-quality chest compressions are difficult to deliver in support of cardio-cerebral fusion. Due to limited physical space, rescuers must wear a lead-apron and be able to stretch their hands at an angle because of the C-arm or other cath lab equipment.
This can cause ineffective compressions as well as easy fatigability. You may also be asked to hold compression (“hold compression”) by the operator if you are trying to reverse the problem ( e.g). The balloon should be used to open the occluded vessel.
Radiation exposure poses health risks to the rescuer (being right next to the Xray source and having his hands in the beam), and can cause orthopedic injuries due to poor ergonomics and panning of cath tables. Poor visualization of the Xray field by the operator and the excessive movement of the heart during compression can also cause procedural problems for the operator.
Manual Chest Compression Alternatives When in Cath Lab
Manual chest compressions are not able to provide adequate circulatory support in cardiac arrest. Alternative methods have been explored. The ideal circulatory support strategy is one that allows adequate perfusion of vital organs (most important, the brain, and coronaries), is readily available, cost-effective, and has low complications.
The current circulatory support options can be broken down into the mechanical compression devices (MCD) or the invasive percutaneous manual circulatory support device (Table ). The three most commonly available mechanical chest compression devices (commercially available) are the LUCAS TM (Lund University Cardiopulmonary Support System), LifeStat TM, AutoPulse r, V-A ECMO (venoarterial extracorporeal membrane oxygenation), and Impella are the two most common percutaneous mechanical circulatory supports devices (pMCSs) that can be used in cardiac arrest.
If a patient is at high risk of cardiac arrest, the “hemodynamic Support” strategy can be used. This involves inserting a pMCS before any actual PCI. This strategy relies on the assumption that pMCS may reduce cardiac arrest risk during an ischemic injury. In the case of hemodynamic collapse, circulatory supports are already in place to support organ perfusion.
The operator can then focus his efforts on correcting the precipitating factor. TandemHeart r left atrial-to aorta extracorporeal system may be used to achieve the same purpose. An intra-aortic balloon pump may reduce ischemia by increasing coronary flow.
However, it is not effective in cases of cardiac arrest. There are two main problems with this approach: the risk of pMCS insertion, which can often require multiple large vascular catheters, and the high price of the pMCS.
That all the part of how actually cardiac cath lab can significantly save patient life through its complex and precise procedures.
For more detail journal about how cardiac cath lab procedures, you can go to : ncbi.nlm.nih.gov