61yo male OOHCA
Visiting a friend and collapsed whilst walking to the kitchen. Immediate CPR. Ambulance on scene and witnessed "good" CPR.
The initial prehospital ecg strip showed ?VT ?Torsades - shocked a dozen times as well as bolus and infusion adrenaline and got ROSC x3 during a delayed transfer (heavy rain with poor visibility)
ASSESSMENT ON ARRIVAL
B - Sat 86% RR 16 spont
C - BP 105/80 HR 80 Sinus ECG pending
D - GCS4 (M2) without sedation/paralysis
DEFG - normoglycemic
E - T35
The ecg that generated some discussion is shown here
NB ecg changes from intracranial pathology can be highly variable and often not pathognomonic…apart from bradycardia (when the brain herniates).
What are some of the predictive factors for OOHCA from intracranial pathology?
Arnout (2) (86 confirmed primary cerebrovascular from 3710 OOHCA)
Noc (3) on behalf of the European association for percutaneous cardiovascular interventions/stent for life group s published a consensus statement on this:
Which demographic are more likely to have +ve angio's? (4)
What about the ecg…is that a good predictor of +ve angio? (5)
Predictors of Favourable Outcome
Predictors of Poor Outcomes
Also Keep in Mind other factors
It was also discussed that the term "down-time" is confusing - some mean from Arrest to CPR or Arrest to ROSC. This is important because you can a prolonged period of time between Arrest and ROSC but with good outcomes if appropriate CPR and ALS is achieved.
Somatosensory evoked potentials
- Hubner et al: Neurologic causes of cardiac arrest and outcomes. J Emerg Med. 2014 Dec;47(6):660-7
- Arnaout et al: Out-of-hospital cardiac arrest from brain cause: epidemiology, clinical features, and outcome in a multicenter cohort. Crit Care Med. 2015 Feb;43(2):453-60
- Noc et al: Invasive coronary treatment strategies for out-of-hospital cardiac arrest: a consensus statement from the European association for percutaneous cardiovascular interventions/stent for life groups. EuroIntervention. 2014 May;10(1):31-7
- Aurore et al: Predictive factors for positive coronary angiography in out-of-hospital cardiac arrest patients. Eur J Emerg Med. 2011 Apr;18(2):73-6
- Zanuttini et al: Predictive value of electrocardiogram in diagnosing acute coronary artery lesions among patients with out-of-hospital-cardiac-arrest. Resuscitation. 2013 Sep;84(9):1250-4
- Iqbal et al: Predictors of survival and favorable functional outcomes after out-of-hospital cardiac arrest in patients systematically brought to a dedicated heart attack center (from the Harefield Cardiac Arrest Study). Am J Cardiol. 2015 Mar 15;115(6):730-7