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Practicing for Emergencies in the Cath Lab: The REACT Protocol

Monday, July 1, 2019

Dunning J, Menon M, Chan B, et al.. Practicing for Emergencies in the Cath Lab: The REACT Protocol. July 2019. doi:10.25373/ctsnet.8295473.

This is a video on how the authors are working as a team to improve the outcomes of people who arrest or have an acute emergency in the catheterization laboratory (cath lab) during procedures of all types including transcatheter aortic valve replacement (TAVR), percutaneous coronary intervention, pacing, atrial fibrillation ablation, and soon transcatheter mitral valve replacement. A team based in New Zealand together with a cardiothoracic team experienced in emergency planning have collaborated to develop this protocol to improve the outcomes of these stressful events.

Can you think of a case in the cath lab that went wrong? Perhaps the patient’s heart arrested, perhaps there was a tamponade, or maybe the heart didn’t even arrest but it was a tremendously stressful event for you and all the staff involved. Well, you are not alone. We all experience situations like this. Thankfully it is rare, but precisely because it is a rare event, this allows us to go back to the way we usually work in our busy centers, dealing successfully with large numbers of increasingly elderly and unwell patients, and that last traumatic and stressful case becomes a distant memory… until the next time!

The authors have formed a group of dedicated clinicians who realize how different it is working in a modern cath lab today. Like in all fast-changing environments, we face new and more difficult challenges while our hospitals become less accepting of complications. Together, the authors feel that standard adult cardiac life support is not fit for purpose in the cath lab and these teams need their own way of dealing with the many, very specific complications they face. They need to train and practice together as a team to make sure that these complications are dealt with quickly and efficiently, according to protocols that have been agreed upon together in advance.

That is the basis for the REACT protocol. There are no new emergencies and people all over the world face these challenges every day, so we need to learn from each other and set out an approach to deal with a coronary vessel dissection, a tamponade after left atrial ablation, a left main stem occlusion in a TAVR procedure, and even the more common oversedation, pneumothorax, allergic reactions, and many other less dramatic complications that if dealt with quickly and efficiently as a team, can lead to a quick recovery.

Joel Dunning is cofounder of, a group that seeks to implement the STS protocol in resuscitation after cardiac surgery. They seek to do a similar protocol in cath lab emergencies, which is shown here.

This video is part of the series Nontechnical Skills in Cardiothoracic Surgery, brought to you by CTSNet Guest Editor Professor Jean-Marc Baste. Find the whole series here.

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