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…
Latest posts by Scott Weingart (see all)
- EMCrit RACC 228 – Physiology-Guided Cardiac Arrest Management in 2018 with Dr. Robert Sutton - July 11, 2018
- EMCrit RACC – A Refractory Anaphylaxis Mock Trial by Mike Weinstock - July 5, 2018
- EMCrit Podcast – Acid Base Ep. 7 – Bicarb Updates, Quantitative Approach, and Prof. David Story - June 28, 2018