Welcome to the STS-ACC TVT Registry Case Scenario, where we will review sequence number 9002, intra-post-procedure events occurred, as it relates to capturing a cardiac arrest. An 84-year-old patient with a diagnosis of aortic stenosis was admitted for a TAVR procedure. The patient had a V-fib arrest during the TAVR procedure, with return of spontaneous circulation after one defibrillation. After the procedure was completed, but before the patient was moved off the cath lab table, he had another episode of V-fib arrest, with return of spontaneous circulation after one defibrillation the same day. Post-procedure echo revealed pericardial effusion. Pericardiocentesis was performed, and the patient was transferred to the ICU. Is this captured as a cardiac arrest in sequence 9002, intra-post-procedure events occurred? Number one, no, or number two, yes. Please take a few moments to review the documentation before making your final selection. And the answer is number two, yes. Per the data dictionary, cardiac arrest is defined as an acute cardiac event documented by one of the following, ventricular fibrillation or rapid ventricular tachycardia or bradycardia rhythms with hemodynamic compromise causing loss of consciousness or pulseless rhythms or asystole requiring cardiopulmonary resuscitation. And without these measures, death would have almost certainly resulted. As the patient experienced an acute cardiac event of ventricular fibrillation that required cardiopulmonary resuscitation, in this case defibrillation, between the start of procedure and discharge, cardiac arrest would be captured as the definition is met. So now that we have reviewed the definition in its entirety, let's test your knowledge with some practice questions. And let's start with a new scenario. If after the TAVR lab procedure starts, the patient experiences ventricular tachycardia that converts back to sinus rhythm after two synchronized shocks, otherwise known as cardioversion. Is this captured as a cardiac arrest in sequence number 9002, intra-post-procedure events? And the answer is no. And again, we point to that data dictionary definition. In this scenario, while the patient experienced an acute cardiac event of ventricular tachycardia and required cardioversion times two, there is no documentation supporting it was a rapid ventricular tachycardia causing hemodynamic compromise and loss of consciousness to meet the definition. Therefore, cardiac arrest would not be captured in this scenario. So changing things up, what if after the TAVR procedure completed, the patient experiences asystole? However, due to a new DNR status, no cardiopulmonary resuscitation efforts are made and the patient expires. Is this captured as a cardiac arrest in sequence 9002? And the answer is yes. Now, we know, we know, that was a little bit of a tricky question, but hold the tomatoes. As per the data dictionary, cardiac arrest is defined as an acute cardiac event documented by one of the following. Ventricular fibrillation or rapid ventricular tachycardia or bradycardia rhythms with hemodynamic compromise causing loss of consciousness. Pulseless rhythms or asystole. Requiring cardiopulmonary resuscitation. And without these measures, death would have almost certainly resulted. However, there's more. A note further clarifies that if an event occurs that meets the above definition of cardiac arrest, in this case, asystole, code yes, regardless of a resuscitation status of DNR, hospice, or comfort care. Thank you for viewing the TVT Registry case scenario.

STS-ACC TVT Registry

cardiac arrest

ventricular fibrillation

defibrillation

pericardial effusion