MedicalResearch.com Interview with:
Won Young Kim, MD
Department of Emergency Medicine
Ulsan University College of Medicine
Asan Medical Center
MedicalResearch.com: What is the background for this study?
Response: The current advanced cardiac life support guidelines recommended emergent percutaneous intervention for out-of-hospital cardiac arrest (OHCA) survivors with ST-segment elevation and suspected cardiac origin without ST-segment elevation. However, spontaneous subarachnoid hemorrhage (SAH) is a well-known cause of cardiac arrest, and its electrocardiogram may mimic myocardial infarction or ischemia. The need and timing for brain computed tomography in non-traumatic OHCA remain controversial.
The present study aimed at determining the role of the post-resuscitation ECG in patients with significant ST-segment changes on initial ECG to investigate the difference in post-resuscitation ECG characteristics between OHCA patients with SAH and those with suspected cardiac origin of OHCA.
MedicalResearch.com: What are the main findings?
Response: In out-of-hospital cardiac arrest survivors with significant ST-segment changes on their post-resuscitation electrocardiogram, the combination of 4 ECG characteristics including narrow QRS (<120 ms), atrial fibrillation, prolonged QTc interval (≥460 ms), and ≥4 ST-segment depressions could be a predictive tool of SAH. Resuscitated patients with narrow QRS complex and any 2 ECG findings of atrial fibrillation, QTc interval prolongation, or 4≥ ST-segment depressions had 66.0% sensitivity, 80.0% specificity, 52.4% positive predictive value, 87.6% negative predictive value, 3.3 positive likelihood ratio, and 0.4 negative likelihood ratio. The AUC in our post-resuscitation ECG findings was 0.816 (95% CI: 0.751 to 0.880) for SAH
MedicalResearch.com: What should readers take away from your report?
Response: The interpretation of post-resuscitation ECG may be used as a predictive tool to determine the next diagnostic work-up in out-of-hospital cardiac arrest survivors. Although the timing of brain CT and CAG has been controversial, immediate brain CT could be considered in resuscitated patients with a narrow QRS complex and any 2 ECG findings may help identify patients who need brain CT as the next diagnostic work-up before coronary angiography.
MedicalResearch.com: What recommendations do you have for future research as a result of this study?
Response: Prospective multicenter studies are needed to validate the predictive value of the ECG findings proposed in this study, especially in the western area.
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