Electrophysiology Procedures & Cardiac Rhythm Management —
Training activity: 28

Details

Recognise and assist with the management of the following significant complications in the CRM lab:

• Tamponade
• Pneumothorax
• Cardiac arrest
• Severe bradycardia

Type

Entrustable training activity (ETA)

Evidence requirements

Evidence the activity has been undertaken by the trainee repeatedly, consistently, and effectively over time, in a range of situations. This may include occasions where the trainee has not successfully achieved the outcome of the activity themselves. For example, because it was not appropriate to undertake the task in the circumstances or the trainees recognised their own limitations and sought help or advice to ensure the activity reached an appropriate conclusion. ​

Reflection at multiple timepoints on the trainee learning journey for this activity.

Reflective practice guidance

The guidance below is provided to support reflection at different time points, providing you with questions to aid you to reflect for this training activity. They are provided for guidance and should not be considered as a mandatory checklist. Trainees should not be expected to provide answers to each of the guidance questions listed.

Before action

What does success look like?

• Identify what is expected when recognising and assisting with the management of these specific complications in the CRM lab.
• Consider how the relevant learning outcomes apply, specifically regarding ensuring patient safety and regarding identifying changes requiring escalation.
• Discuss with your training officer to gain clarity on expectations for recognising signs (e.g., changes in ECG or haemodynamic data) and your role in assisting emergency management.

What is your prior experience of this activity?

• Think about what you already know about recognising these complications and emergency procedures.
• Consider possible challenges that might arise (e.g., rapid patient deterioration or needing to communicate effectively under pressure) and how you might handle them.
• Recognise the scope of your own practice for this activity, i.e., know when you will need to seek advice or help (e.g., during a cardiac arrest) regarding specific interventions or escalation steps, and from whom.
• Acknowledge how you feel about recognising and assisting with the complications identified.

What do you anticipate you will learn from the experience?

• Consider the specific skills you want to develop related to recognising subtle signs/symptoms of complications (e.g., severe bradycardia), participating in emergency response, and working effectively under pressure.
• Identify specific insights you hope to gain regarding the emergency management protocols in the CRM lab and team coordination during a critical event.

What additional considerations do you need to make?

• Consult actions identified from previous experiences with emergency situations or simulations.
• Identify any important information you need to consider, such as the location of emergency equipment (e.g., resuscitation equipment) or the specific risks associated with the procedure being performed or the patient’s baseline risk factors that you need to consider beforehand.

In action

Is anything unexpected occurring?

• Are you noticing anything surprising or different from what you anticipate whilst monitoring the patient during the procedure?
• Are you encountering situations such as:
  • Identifying subtle signs e.g., muffled heart sounds for tamponade, decreased breath sounds for pneumothorax that indicate a complication, but are difficult to definitively classify?
  • A breakdown in team communication during the crisis, making coordination challenging?

How are you reacting to the unexpected development?

• How is this impacting your actions? For example, are you responding to the situation appropriately? Are you deciding the best way to alert the team quickly?
• Consider the steps you are taking in the moment, such as:
  • Actively concentrating on identifying subtle signs or performing tasks effectively in a high-pressure emergency?
  • Immediately seeking guidance and support from the senior medical and nursing staff when a potential or actual significant complication arises?
• How are you feeling in that moment? For instance, are you finding it difficult to perform tasks effectively in a high-pressure emergency? Is it affecting your confidence in supporting the clinical team’s response?

What is the conclusion or outcome?

• Identify how you are working within your scope of practice. For example, are your assessment, initial assistance, and monitoring tasks appropriate for your level of training and support role during an acute complication?
• What are you learning as a result of the unexpected development? For example, are you learning how the team works together during an emergency response?

On action

What happened?

• Begin by summarising the key points of the experience where one of these complications occurred or was suspected.
• Consider specific events, actions, or interactions which felt important, such as the signs you recognised e.g., sudden hypotension, muffled heart sounds, your immediate actions, and how you assisted in the management e.g., retrieving emergency equipment.
• Include any ‘reflect-in-action’ moments where you had to adapt to the situation as it unfolded, for instance, rapidly assisting with chest compressions or locating and preparing emergency equipment during a suspected Tamponade. How did you feel during this experience?

How has this experience contributed to your developing practice?

• Identify what learning you can take from this experience regarding complication management. What strengths did you demonstrate (e.g., rapid reaction)? What skills and/or knowledge gaps were evident, such as challenges in recognising subtle signs of pneumothorax or working within the emergency response team?
• Identify any challenges you experienced, such as reacting quickly or understanding the appropriate initial steps for these emergencies, and how you reacted to these. How does this activity contribute to your skills in managing medical emergencies in the procedural environment?
• Acknowledge any changes in your own feelings now you are looking back on the experience.

What will you take from the experience moving forward?

• Identify the actions or ‘next steps’ you will now take, including incorporating any feedback received when you assist wit the management of the complications identified.
• Identify specific complications or emergency procedures e.g., severe bradycardia management where you need further training or practice. How will you prepare to respond effectively to these critical events in future? Has anything changed in terms of what you would do if you were faced with a similar situation again?
• Do you need to practise any aspect of the activity further, such as reviewing the location of emergency equipment or team roles during a crisis?

Beyond action

Have you revisited the experiences?

• Have you reviewed your actions from your previous reflections for this activity? What specific signs of deterioration e.g., sudden pressure drops indicating tamponade or steps in the management of these emergencies did you previously find most challenging to identify or execute effectively? Have you completed these previously identified actions? For example, if you planned to review the specific haemodynamic profiles associated with tamponade, how did this improve your recognition skills and understanding of protocols?
• Engage in professional storytelling with peers, near peers, or colleagues about training, simulations, or debriefs related to CRM lab emergencies. Did these opportunities provide new insights into early recognition, rapid response, team coordination (e.g., during a cardiac arrest), or pathophysiology, shaping your approach to future acute situations in the lab?

How have these experiences impacted upon current practice?

• Consider how the accumulated learning from performing or reflecting on managing lab complications will support you in preparing for observed ‘in-person’ assessments for the module, such as a DOPS requiring demonstration of effective communication or technical support during a critical event.
• How has your confidence in recognising acute issues and understanding your role in the emergency response evolved? For example, how does this development demonstrate progress towards providing effective physiological and scientific support, especially in ensuring patient safety during interventional procedures?
• What transferable skills e.g., crisis management, rapid assessment, or communication under pressure did you develop through this activity, and how will this understanding help you contribute to the safety and efficiency of other dynamic cardiac procedures?

Relevant learning outcomes

#	Outcome
# 1	Outcome Demonstrate effective physiological and scientific support for complex CIED implant, providing technical expertise, ensuring patient safety and appropriate procedural documentation.