Cardiology Corner: New Post Cardiac Arrest Guidelines

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Nurses Edition Commentary

Mel Herbert, MD MBBS FAAEM, Kathy Garvin, RN, and Lisa Chavez, RN
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Tamara N. -

Has anyone studied the role of formal bedside echo in non STEMI post arrest rhythm/other grey zone patients to see if regional wall motion abnormalities may be an indication for emergent CATH vs those without can be transferred to ICU??

Quinn C. -

Waiting 15 minutes post-ROSC for possible epinephrine-induced ST/T wave changes to resolve (presuming they aren't ischemic): good or bad idea? Discuss.

Bill Hinckley, MD -

"If the initial post-arrest rhythm was ventricular fibrillation..." : this is oxymoronic.

Amal M. -

Tamara: I don't know if this has been formally studied. The problem with WMA is that if the patient has a completed MI, either recent or remote, then WMA will be present. If it's known to be new, it certainly does push for more aggressive mgmt.

Quinn: In my post-arrest patients, I get an ECG right away but I also get another one 15-20 min later and compare them. If profound ST changes persist, I push harder to get early cath. If ST changes largely resolve, I wouldn't argue as much if there's a delay in cath.

Bill: should be "If the first arrest rhythm was VFib...", not "post-"
Sorry if it was mis-stated.

Amal

Michael H. -

Do you have any literature to support the assertion that "If the initial post-arrest rhythm was ventricular fibrillation, it is a very good predictor of a primary cardiac event". That's certainly been my experience, and physiologically makes a lot of sense, but we've gotten a lot of push back lately from our cardiologists and internests about accepting a patient before we've "ruled out other causes of arrest". Would be nice to have some literature to back this up! Thanks!

Amal M. -

For a great review that has all the references for this topic and many related issues, see the JACC article from July 7 2015 by Rab: Cardiac Arrest: A Treatment Algorithm for Emergent Invasive Cardiac Procedures in the Resuscitated Comatose Patient.

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