One of the basic tenets of post-cardiac arrest care is identifying and addressing
reversible causes for the cardiac arrest.
1.
Unfortunately, the primary cause of an out-of-hospital cardiac arrest (OHCA) is often
unclear during the early resuscitation period. Ischemic heart disease is a common
suspect as it is highly prevalent in comatose survivors of OHCA.
2.
However, cardiovascular risk stratification is reliant on clinical history and the
physical exam, which are often unavailable or difficult to interpret in the early
post-cardiac arrest period. Without this important information, the cardiovascular
assessment in comatose survivors of OHCA can be prone to cognitive biases.
3.
Clinicians often resort to the initial rhythm (ventricular fibrillation or pulseless
ventricular tachycardia versus pulseless electrical activity or asystole) and electrocardiograms
(ECG) recorded post-return of spontaneous circulation (ROSC) to risk stratify ischemic
heart disease as the primary cause of the cardiac arrest.
4.
Cardiac arrests in patients presenting with initial non-shockable rhythms (pulseless
electrical activity or asystole) and no ST-segment elevation are deemed less likely
to be the result of an acute coronary culprit and therefore undergo coronary angiography
less frequently.
- McFadden P.
- Reynolds J.C.
- Madder R.D.
- Brown M.
Diagnostic test accuracy of the initial electrocardiogram after resuscitation from
cardiac arrest to indicate invasive coronary angiographic findings and attempted revascularization:
a systematic review and meta-analysis.
Resuscitation. 2021; 160: 20-36
5.
,
6.
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Article info
Publication history
Published online: September 27, 2021
Accepted:
September 15,
2021
Received:
September 12,
2021
Identification
Copyright
© 2021 Published by Elsevier B.V.
