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…
- EMCrit Wee – Webinar I Gave to Pulm/Crit Care Fellows on Avoiding Intubation and Initial Ventilation of COVID19 Patients - April 4, 2020
- EMCrit 269 – Rationing of Critical Care and Ventilators in COVID19 with Reub Strayer - March 31, 2020
- EMCrit Wee – Stop Kneejerk Intubation with the EMCrit Crew - March 30, 2020