Basics of the Cath Lab: Resources for CVPs, Fellows, and the Cath Curious-PCI Complications

Video Transcription

Video Summary

In this video, Saurabh Joshi, an interventional cardiologist, discusses major complications with percutaneous coronary intervention (PCI) and provides guidance on their management. Joshi emphasizes the importance of preparation, early recognition, and a team-based approach in handling these complications. He suggests having multidisciplinary collaboration, with interventional cardiologists available for assistance during emergencies, CT surgery notified and ready if needed, and a shock team on standby. All cath lab staff should feel comfortable raising concerns about potential or active complications. Joshi recommends that cath labs be equipped with a cart or kit containing various equipment to address complications, including tools for pericardiocentesis, covered stents for perforation, coils and microcatheters for embolization, snares, and mechanical circulatory support devices. He highlights the need for experienced cardiac ICU care and resources such as perfusion teams and echocardiography. If a hospital lacks CT surgery backup, there should be a plan in place for emergent transfer of patients to facilities with necessary resources. Joshi provides an algorithm for managing complications, emphasizes the importance of assessing perfusion, oxygenation, and ventilation, and offers specific approaches for different complications such as coronary dissection, vessel perforation, and no-reflow phenomena. In the case of allergic reactions to iodinated contrast media, Joshi discusses the importance of identifying and treating mild, moderate, and severe reactions with appropriate medications, including diphenhydramine, epinephrine, and steroids.

Asset Subtitle

Saurabh Joshi, MD, FSCAI

Keywords

interventional cardiologist

percutaneous coronary intervention

complications management

team-based approach

cath lab equipment