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JACC Cardiovasc Interv. 2017 Mar 13;10(5):451-459. doi: 10.1016/j.jcin.2016.11.046.

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

Author information

1
Department of Emergency Medicine, Ulsan University College of Medicine, Asan Medical Center, Seoul, Korea.
2
Health Screening and Promotion Center, Asan Medical Center, Seoul, Korea.
3
Department of Emergency Medicine, Chonnam National University Hospital, Gwangju.
4
Department of Emergency Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea.
5
Department of Internal Medicine, Ulsan University College of Medicine, Asan Medical Center, Seoul, Korea.
6
Department of Emergency Medicine, Ulsan University College of Medicine, Asan Medical Center, Seoul, Korea. Electronic address: wonpia73@naver.com.

Abstract

OBJECTIVES:

The authors aimed to evaluate the role of post-resuscitation electrocardiogram (ECG) in patients showing significant ST-segment changes on the initial ECG and to provide useful diagnostic indicators for physicians to determine in which out-of-hospital cardiac arrest (OHCA) patients brain computed tomography (CT) should be performed before emergency coronary angiography.

BACKGROUND:

The usefulness of immediate brain CT and ECG for all resuscitated patients with nontraumatic OHCA remains controversial.

METHODS:

Between January 2010 and December 2014, 1,088 consecutive adult nontraumatic patients with return of spontaneous circulation who visited the emergency department of 3 tertiary care hospitals were enrolled. After excluding 245 patients with obvious extracardiac causes, 200 patients were finally included.

RESULTS:

The patients were categorized into 2 groups: those with ST-segment changes with spontaneous subarachnoid hemorrhage (SAH) (n = 50) and those with OHCA of suspected cardiac origin group (n = 150). The combination of 4 ECG characteristics including narrow QRS (<120 ms), atrial fibrillation, prolonged QTc interval (≥460 ms), and ≥4 ST-segment depressions had a 66.0% sensitivity, 80.0% specificity, 52.4% positive predictive value, and 87.6% negative predictive value for predicting SAH. The area under the receiver-operating characteristic curves in the post-resuscitation ECG findings was 0.816 for SAH.

CONCLUSIONS:

SAH was observed in a substantial number of OHCA survivors (25.0%) with significant ST-segment changes on post-resuscitation ECG. Resuscitated patients with narrow QRS complex and any 2 ECG findings of atrial fibrillation, QTc interval prolongation, or ≥4 ST-segment depressions may help identify patients who need brain CT as the next diagnostic work-up.

KEYWORDS:

cardiac arrest; electrocardiogram; myocardial infarction; resuscitation; subarachnoid hemorrhage

PMID:
28279312
DOI:
10.1016/j.jcin.2016.11.046
[Indexed for MEDLINE]
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