Using Post-Resuscitation ECG To Predict Need For Brain CT Interview with:

Won Young Kim, MD Department of Emergency Medicine Ulsan University College of Medicine Asan Medical Center Seoul, Korea

Dr. Won Young Kim

Won Young Kim, MD
Department of Emergency Medicine
Ulsan University College of Medicine
Asan Medical Center
Seoul, Korea 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. 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 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. 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. Thank you for your contribution to the community.


JACC: Cardiovascular Interventions

The Role of Post-Resuscitation Electrocardiogram in Patients With ST-Segment Changes in the Immediate Post-Cardiac Arrest Period

Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.

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Last Updated on March 8, 2017 by Marie Benz MD FAAD