Post Out of hospital cardiac arrest ecg's

The are a number of studies in the literature looking at the value of the ECG after an Out of Hospital Cardiac Arrest with ROSC.

Circ Cardiovasc Interv. 2015;8:e002784. DOI: 10.1161/CIRCINTERVENTIONS.115.002784.
​
This 2015 paper looked at 210 Patients who had ROSC after an out of hospital cardiac arrest.

The post arrest ECG was classified into 3 main groups.
1) ST elevation or presumably new left bundle branch block
(2) Other ECG signs indicating myocardial ischaemia
(3) No ECG signs indicating myocardial ischaemia. 

Coronary Angiography findings were then correlated with the ECG findings. 

Notable findings were:
1) Mean age 62 +/- 12 years
2) 6 Month survival with good neurological outcome 54%
3) STEMI or presumed new LBBB identified patients with reduced TIMI flow with sensitivity 70%, specificity 62%.

4) An acute coronary occlusion was found in 11% of patients in group (3), those with a post resuscitation ecg showing no signs of Myocardial Ischaemia. 
5) 32% of patients with initial non shockable rhythms had significantly reduced TIMI flow at angiography. 

What does this tell us?
After initial resuscitation of the patient with an Out of Hospital Cardiac Arrest consider carefully the need for Emergency PCI even if the ecg shows no ischaemia. 

Want to read more?
https://rebelem.com/the-difoccult-trial-time-to-change-from-stemi-nstemi-to-omi-nomi/
This October 2020 paper and post highlighted by Nick Pocock proposes a new way of thinking in Post Cardiac Arrest Care. 

Steve Fordham November 2020