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Complication
Management In
TheCardiac Catheter
Laboratory
ErhardKaiser
Editor
123
Complication Management In The Cardiac Catheter
Laboratory
Erhard Kaiser
Editors
Complication
Management
InThe Cardiac
Catheter
Laboratory
Editor
Erhard Kaiser
Private Practice for Internal Medicine and Cardiology
Frankfurt am Main, Germany
ISBN 978-3-662-66092-8 ISBN 978-3-662-66093-5 (eBook)
https://doi.org/10.1007/978-3-662-66093-5
© The Editor(s) (if applicable) and The Author(s), under exclusive license to SpringerVerlag GmbH, DE, part of Springer Nature 2022, 2023
This work is subject to copyright. All rights are solely and exclusively licensed by the Publisher, whether the whole or part of the material is concerned, specically the rights of
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The publisher, the authors, and the editors are safe to assume that the advice and information in this book are believed to be true and accurate at the date of publication. Neither
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DE, part of Springer Nature.
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For my family
V
Foreword I
Today, diagnostic cardiac catheterization as well as interventional catheter techniques have a high success rate and only a low complication
rate. For diagnostic cardiac catheterization, this is 0.9% and for interventional catheterization 2% according to the last statistics of the BQS
for North Rhine-Westphalia.
Thus, a cardiac catheterization is usually performed uncomplicatedly
and quickly in stable patients. However, the quality of a surgeon only
becomes apparent when unexpected or self-induced complications
occur. The excellence, also of the entire catheter team, is then reected
in the management of such situations.
Dr. ErhardKaiser, Frankfurt, and other co-authors therefore set out
to describe complication management in the cardiac catheterization
laboratory in detail and to identify possible solutions. The prevention of
a complication begins, of course, with patient preparation and this also
includes a correspondingly detailed anamnesis and information. Especially in this area, problems are found again and again when procedures
end up in court.
In the cardiac catheterization laboratory, the authors distinguish
function-related complications from complications caused by catheter
placement. Of course, complications of coronary interventions occupy
a large space. Complications from coronary wire placement, balloon
catheter, and stent implantation are considered in a differentiated manner. Of particular importance and especially difcult to treat are thromboembolic complications, which are also discussed below.
Contrast-induced problems are another major topic, as is airway
management up to and including cardiopulmonary resuscitation.
Particularly noteworthy is also the nal chapter on error management with borrowings taken from aviation and certainly a highlight in
this book.
Finally, educational and training situations in interventional cardiology in Germany are presented and follow-up care is discussed.
The book by E.Kaiser closes a gap in the German-speaking world
since a summary treatise on complication management was missing
until now. The clinical experiences of more than 20 years of interventional work in the cathlab in various hospitals and his own achievements as a trainer for catheter based procedures, but also in the
committees of the ESC and the German Society of Cardiology, have
strongly inuenced the writing of this book.
I wish this book every success and I am pleased that a summary work
on this important subject is nally appearing.
R.Erbel
Clinic for Cardiology
West German Heart Center
Essen, Germany
November 2012
VII
Foreword II
Health care has transformed society with dramatic improvements in the
prevention and treatment of all disorders. However, in key reports
including “To Err is Human: Building a Safer health System” and
“Crossing the Quality Chasm: A New Health Care System for the
Twenty-First Century” the Institute of Medicine has laid out the challenges of optimizing the medical care system and the importance of
addressing the fundamental truth that human performance signicantly
accounts for both success and failure in caring for patients.
This book is important because it presents not only what can go
wrong during procedures, i.e. the long list of potential complications,
but also addresses the human performance and system issues that must
be understood to prevent, recognize, and effectively manage complications. This approach is a major departure from prior textbooks and
reviews that have addressed complications. A wide range of information
has been published on the various complications and management
strategies; however, the present knowledge is not enough to produce
change. Drawing on lessons from the aviation industry, the ability to
create true and sustained change requires medicine to rst perform an
analysis of how things can suddenly go badly in the cardiac catheterization laboratory.
This textbook does not exist alone but is linked to the practical and
interactive training courses developed by Dr. Kaiser. These courses
highlight the human performance issues of not only individuals but also
teams. Using many innovative training methods and technologies, his
courses have established a unique and effective approach to improving
human performance in health care. The use of simulation has been a
major part of this shift in training paradigm.
Interventional cardiology has always been a eld founded on solid
scientic studies that have allowed us to understand the right treatment
for the right patient. It has an extensive literature allowing us to classify
the evidence, determine appropriateness, and to provide clinical guidelines in the management of patients with coronary, vascular, and structural heart disease. This book takes the interventional eld into a new
domain of improving how we deliver the care dictated by best practices.
No matter how strong and persuasive the clinical trial data are to support the need for a procedure, the safe and effective performance of the
procedure is a completely separate process. Dr. Kaiser and the authors
of chapters in this book focus us on understanding complications in a
way that will lead to safer and more effective procedures.
JohnD.Carroll
Professor of Medicine
University of Colorado Denver
Denver, CO, USA
Former Director, Interventional Cardiology
Cardiac and Vascular Center, University of Colorado Hospital
Aurora, CO, USA
Preface to the Second Edition
Interventional cardiology is one of the most rapidly developing medical
disciplines. Interventional procedures on the beating heart, which would
have been unthinkable in the past, have become routine procedures
today, and there is no end in sight to the technical and methodological
development. Nevertheless, not everything that is technically feasible
must ultimately be done today and our patients should always be the
focus and benet from the procedures performed.
Against this background, complication management in the cardiac
catheterization laboratory has lost none of its topicality and importance. On the contrary, the more complex our procedures become, the
more likely it is that procedure-related complications will occur, and the
greater the demands on the quality of the surgeons and cardiac catheterization laboratory teams must be. So learning and training together
doesn’t stop, it goes on and on.
With this in mind, we have given the book a complete overhaul, adding to and updating all the chapters.
May this book continue to contribute to the establishment of a constructive approach to errors and a functioning complication management in interventional cardiology.
ErhardKaiser
Frankfurt am Main, Germany
June 2020
IX
Preface to the First Edition
Today, interventional therapy in the cardiac catheterization laboratory
plays a central role in the treatment of a wide variety of cardiovascular
diseases. Procedures that would have been unthinkable years ago, such
as percutaneous aortic valve replacement, but also complex coronary
interventions, are now performed worldwide in large numbers and with
good treatment success. Our great gratitude within the cardiology community is therefore still due today to the pioneers of interventional cardiology (Andreas Grüntzig and Werner Forssmann may be mentioned
here only as representatives), who with their pioneering spirit and skill
took the rst steps from which we still benet today.
Since we have long left the age of pure diagnostics behind us (discovery of X-rays, development of X-ray contrast media, and the rst angiographies), we have been living and experiencing the age of interventional
therapy in many ways on a daily basis. However, for the past 10years,
interventional cardiology has been increasingly, and quite rightly, focusing on patient safety, challenging us to rethink more than ever before. In
particular, the younger generation of interventional cardiologists is now
challenged to establish a culture of error in their cardiology departments, which still seems difcult in many places. This book aims to contribute to a change of mood in the respective departments.
I am proud and pleased to have found co-authors for this book who
all represent this young and new generation of interventional cardiologists, who are fully committed to patient safety and who, in addition to
their daily interventional work, have also shown great personal dedication to cardiology education and training as well as patient safety. The
same pioneering spirit may also be attested to all of them again because
with innovative training concepts, namely simulator-supported teaching, we manage today to operate a complication management that
would also have been unthinkable in the past and is hardly inferior to
reality today.
My wish with this book is to contribute to a constructive approach to
errors and complications in interventional cardiology. May this book
become a permanent thematic part of interventional training and
become embedded in the essence of the current, but also of all future
generations of cardiologists.
ErhardKaiser
Frankfurt am Main, Germany
November 2012
Acknowledgements
I would like to expressly thank all the contributors to this book who, in
addition to all their professional and private commitments, have managed to devote themselves to the teaching and further development of
the subject of cardiology, thus helping young physicians and teams in
their daily work in the cardiac catheterization laboratory and acting in
the service of patient safety. My special thanks go to Ms. Kerstin Barton
and Mr. Hinrich Küster from Springer Verlag for their competent and
patient support.
Above all, I would also like to thank my wife Nataša and my daugh-
ter Carla Anja, who always give me the strength and peace for my work.
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