Access & Closure, Hemodynamics, Protected PCI

Karim Ibrahim: Handling High-Risk Patients in the Cath Lab


Prof. Karim Ibrahim, first author of the publication “Handling high-risk patients in the catheterization laboratory” discusses key aspects of managing high-risk patients. This is 1 of 8 articles published in European Heart Journal Supplements in 2022 describing best practices in Protected percutaneous coronary intervention (PCI).

Prof. Ibrahim highlights the importance of preparation prior to high-risk procedures, emphasizing the need to discuss the revascularization strategy with the whole team to prepare for complications. “Everybody on the team should know the case and they should be prepared for all possible complications with training prior to emergency situations.”

Prof. Ibrahim also discusses the importance of standard protocols, including right heart catheterization prior to and throughout the procedure. “And usually in our team, we train all the emergent situations outside real emergencies so that the whole team has a good training for that, and we all stick to standards in our clinic.” He emphasizes the importance of vascular access and experience with vascular closure devices. “You shouldn’t start with the Impella® device without having trained these vascular access devices because they need a little training before using it, or before safely using it.” 

He explains that his team uses standard protocols during PCI procedures. “We use this right heart catheterization throughout the whole procedure for monitoring and possible deterioration of the patient during the procedure,” he states. “You should monitor the central venous pressure, which can identify right heart failure during the procedure. You can manage to monitor the LVEDP and the mean arterial pressure, and taken all together, you can have a look at the clinical condition of the patient.”

In conclusion, Prof. Ibrahim states, “So maybe a high risk patient can safely be treated with the Impella [heart pump] as Protected PCI, and therefore a high-risk patient can be turned into, maybe, a protected patient.”

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