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…

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  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.

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