Who to Cath Post-Arrest?

Steve Smith has an excellent post on 2 cases of post-arrest with EKG changes. Some of my ED critical care buds, Dr. Smith, and I had some back and forth on who actually needs cath post-ROSC. The evidence is mixed.

What I would recommend at this stage of the game is the following patient groups should be cathed in the immediate Post-ROSC period:

  • Conventional STEMI criteria (Anatomically-Sequential ST elevations, Sgarbossa LBBB) You may want to make sure the pattern persists on a repeat EKG
  • Clear Ischemic EKG that persists 20-30 minutes into resuscitation (As Dr. Smith’s post explains, immediate EKGs post-arrest may look ischemic, but resolve during the ED course)
  • Electrical Storm/Persistent Ventricular Dysrhythmia
  • Severe Cardiac Stunning (To look for a lesion and to place IABP)

Some would argue any patient whose rhythm was V-Fib/V-Tach without an alternate non-cardiac cause should take a trip to the lab early in their hospital course.

Love to hear your thoughts…

You finished the 'cast,
Now get CME credit

Not a subcriber yet? Why the heck not?
By subscribing, you can...

  • Get CME hours
  • Support the show
  • Write it off on your taxes or get reimbursed by your department

Sign Up Today!

.

Subscribe Now

If you enjoyed this post, you will almost certainly enjoy our others. Subscribe to our email list to keep informed on all of the ED Critical Care goodness.

This Post was by , MD, published 2 years ago. We never spam; we hate spammers! Spammers probably work for the Joint Commission.

Comments

  1. Cherinor Sillah says:

    Hi Scott,
    Do you know of any good article on risk stratification of patient that present with chest pain with negative Cath less than 2 years or positive Cath with stent less or equal 2 years? I have been looking for a good but has found one.
    Thanks.
    Cherinor

Speak Your Mind (Along with your name, job, and affiliation)