This is the IMPACT Registry June 2020 case scenario, reviewing metric 24, cardiac catheterization adverse events, isolated procedures, patients greater than 1 year to less than or equal to 18 years of age. A 12-year-old male presents to the cath lab for a diagnostic coronary angiography. The patient has a history of PDA closure and has recently experienced chest tightness and shortness of breath when running. Initial catheter placement in the aortic root is followed with visualization of the LAD. The patient becomes diaphoretic and complains of severe chest and back pain. The physician discovers a catheter-induced aortic dissection and alerts the cath team to call the OR. The patient quickly deteriorates and experiences V-fib arrest requiring two defibrillations. Once sinus rhythm is established, the patient is rushed to the OR for cardiac surgery. Question 1. Will this case be included in the numerator of metric 24, cardiac catheterization adverse events, isolated procedures, patients greater than 1 year to less than or equal to 18 years of age? 1. No. 2. Yes. Please take a few seconds to review the documentation and question. The answer is yes. This patient had an isolated cardiac catheterization in which the patient suffered cardiac arrest and required unplanned cardiac surgery due to a cath complication. Additionally, this procedure does not meet any exclusion criteria listed below. Since only a cardiac catheterization was performed, this case is an isolated procedure. Question 2. Will this patient be reflected twice in metric 24 since there were two adverse events in the same cath lab visit? 1. Yes. 2. No. The answer is no. This metric measures procedures, not number of adverse events. When multiple adverse events occur in one procedure, the patient is still only counted once in metric 24. Thank you for viewing the Impact Registry Monthly Case Scenario for June 2020.

IMPACT Registry

case scenario

12-year-old male

diagnostic coronary angiography

catheter-induced aortic dissection