Out of hospital cardiac arrest (OHCA) is a devastating clinical occurrence with historically poor long-term outcomes. According to the American Heart Association, there were more than 350,000 cases of OHCA in 2016, and overall survival was low at 12%. The initial rhythm of patients presenting with OHCA defines the strategy of management after return of spontaneous circulation (ROSC), patients with VF/VT or “shockable rhythm” are more likely to have underlying coronary artery disease (CAD), and specifically, an acute thrombotic coronary occlusion (ATCO), as the precipitating cause of the OHCA. Immediate coronary revascularization is recommended if ATCO is suspected in the context of resuscitated OHCA.

Following ROSC, an immediate 12-lead electrocardiogram (ECG) is a critical test to triage patients for immediate invasive coronary angiography (ICA), usually by identifying a current of injury or ST-segment elevation (STE). However, it is often difficult to accurately predict angiographic ATCO based on the immediate post-arrest ECG due to several potential caveats and pitfalls impacting the accurate interpretation of the ECG tracing. In particular, clinicians may have reduced confidence in the accuracy of the first 12-lead ECG in identifying ATCO when obtained in the context of an abnormal metabolic milieu (AMM) following ROSC. In this setting, metabolic abnormalities (affecting lactate, pH, as well as derangements in potassium levels), could potentially adversely affect the accuracy of the initial 12-lead ECG. Frontline clinicians may disregard the initial ECG due to these metabolic abnormalities, and instead rely upon a follow-up ECG to predict presence or absence of ATCO, performed after some of the metabolic abnormalities have been corrected. Lack of recognition of findings of ATCO or incorrect attribution of ECG abnormalities to metabolic factors, could result in critical delays in performance of immediate coronary angiography and revascularization.

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Cardiac and Pulmonary Rehabilitation