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…
Editor-in-Chief, EMCrit.org at EDECMO LLC
An ED Intensivist from NY. No conflicts of interest (coi).
Latest posts by Scott Weingart (see all)
- EMCrit 281 – Why Can't Emergency Medicine and Trauma Surgery Just Get Along? - September 4, 2020
- EMCrit 280 – Who Should Get Angiotensin II with Rinaldo Bellomo - August 19, 2020
- EMCrit Wee – Is it Tamponade with Jacob Avila - August 17, 2020
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