Interventional cardiology units are highly specialized environments in which the technical and clinical complexity of the procedures performed – often in urgent or emergency settings and in high-risk patients – places increased demands on multidisciplinary teams, and particularly on their readiness to manage critical situations.

Although cardiac arrest in this setting is relatively uncommon, with an estimated incidence of approximately 3.5%,1,2 its clinical impact is significant, as it is associated with mortality ranging from 15% to 34%.3,4 It is therefore essential that teams are properly prepared to respond rapidly, quickly, and effectively to these events. The wide range of clinical scenarios and procedures – including coronary and valvular interventions, electrophysiology and pacing – hinders the direct application of general advanced life support (ALS) protocols, which are often poorly suited to the specific characteristics of this setting.5 Acknowledging this gap, the European Resuscitation Council published specific recommendations in 2021 for ALS in interventional cardiology units.6 These guidelines emphasize the importance of differentiated defibrillation strategies, early use of mechanical chest compression devices, implementation of structured checklists and systematic team training. These recommendations were further reinforced in the October 2025 update.7 In 2022, the British Cardiovascular Society, in collaboration with the scientific societies of cardiology and anesthesiology, published the first guidelines specifically dedicated to the management of cardiac arrest in interventional cardiology units (Figure 1), highlighting the need for protocols tailored to this specific setting.8

Figure 1.

Central algorithm for ALS in the cardiac catheterization laboratory.

Adapted from Ref. 8, with authorization.

The REACT program – Resuscitation and Acute Catheter Lab Emergencies – was introduced in 2022 as part of this framework. Developed in Australia and New Zealand, it aims to standardize emergency and ALS algorithms for interventional cardiology units.9 Through hands-on training, clearly defined roles, and structured communication, REACT enables teams to manage a wide range of emergencies in a coordinated and effective manner. The program integrates core principles of conventional ALS with specialized, field-specific interventions such as external mechanical chest compression devices. Its focus on training and simulation has clearly improved outcomes for both patients10,11 and team preparedness12–14 across a variety of clinical scenarios.

In June 2025, the Almada-Seixal Local Health Unit became the first institution in Portugal, within the field of interventional cardiology, to implement the REACT protocols and train its professionals accordingly. This achievement established it as the first national hub to receive international certification and scientific endorsement from the Portuguese Association of Cardiovascular Intervention. This initiative aims to provide training to all professional groups and medical specialties involved in managing emergencies and ALS in interventional cardiology units. Its goal is to achieve nationwide implementation while keeping the patient at the center of care delivery.