Initial ECG does not reliably rule out coronary artery stenosis in cardiac arrest survivors

Optimizing post-resuscitation care has been the focus of Henrik Stær-Jensen’s PhD research.


MAIN RESULTS:

  1. Bradycardia during therapeutic hypothermia is associated with good clinical outcome following cardiac arrest.
  2. Immediate coronary angiography following resuscitation from cardiac arrest should not be based on initial ECG findings.
  3. Different methods of haemodynamic monitoring during post arrest care are not interchangeable.

THESIS DEFENCE:

Thesis: New Clinical perspectives in post-resuscitation care after out-of-hospital cardiac arrest
Candidate: Henrik Stær-Jensen
Time: May 14, 2019 at 13:15
Place: Oslo University Hospital, Ullevål, Labbygget: Grønt auditorium
Link to university website


SUMMARY:

(1)  Comatose survivors treated with therapeutic hypothermia after of out-of-hospital cardiac arrest have better neurological outcome if their heart rate drops below 60 beats per minute, according to Stær-Jensen’s first paper.

111 patients were included in the retrospective cohort study, and heart rate was assessed eight hours after cardiac arrest, when the patients were cooled down to 32-34°C. 60% in the bradycardia group survived with favorable outcome, compared to 37% in the nonbradycardia group. Moreover, the quartile of patients with heart rates below 49 beats per minute had significantly better outcome than the rest, whereas the prognosis was sorst in the quartile with heart rates above 78 beats per minute.

(2) The first ECG is not a reliable tool to identify coronary artery stenosis in patients who have survived cardiac arrest. 210 comatose cardiac arrest survivors were taken to immediate coronary angiography, and stenoses were found even in 19 % of the patients without ECG-indicated angiography.

(3) Stroke volume assessment with different minimally-invasive monitoring devices can be used to monitor hemodynamic development and response to treatment in unstable, newly resuscitated patients following cardiac arrest. However, the metods are not interchangeable. The methods used were PiCCO2® (arterial pulse contour analyses with transpulmonary thermodilution calibration), and FloTrac® and Vigileo® pulse contour analyses without such calibration.


REFERENCES:

(1) Stær-Jensen, H., Sunde, K., Olasveengen, T. M., Jacobsen, D., Drægni, T., Nakstad, E. R., Eritsland, J., & Andersen, G. Ø. (2014). Bradycardia during therapeutic hypothermia is associated with good neurologic outcome in comatose survivors of out-of-hospital cardiac arrest. Critical care medicine42(11), 2401-2408.

(2) Stær-Jensen, H., Nakstad, E. R., Fossum, E., Mangschau, A., Eritsland, J., Drægni, T., Jacobsen, D., Sunde, K., & Andersen, G. Ø. (2015). Post-resuscitation ECG for selection of patients for immediate coronary angiography in out-of-hospital cardiac arrest. Circulation: Cardiovascular Interventions8(10), e002784.

(3) Staer-Jensen, H., Sunde, K., Nakstad, E. R., Eritsland, J., & Andersen, G. Ø. (2018). Comparison of three haemodynamic monitoring methods in comatose post cardiac arrest patientsScandinavian Cardiovascular Journal52(3), 141-148.