title: The Role of Post-Resuscitation Electrocardiogram in Patients With ST-Segment Changes in the Immediate Post-Cardiac Arrest Period.
abstract: 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.
  
  
  
  The usefulness of immediate brain CT and ECG for all resuscitated patients with nontraumatic OHCA remains controversial.
  
  
  
  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.
  
  
  
  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.
  
  
  
  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.
authors.affiliation: Department of Emergency Medicine, Ulsan University College of Medicine, Asan Medical Center, Seoul, Korea.
authors.forename: Youn-Jung
authors.initials: YJ
authors.lastname: Kim
authors.affiliation: Health Screening and Promotion Center, Asan Medical Center, Seoul, Korea.
authors.forename: Sun-Yang
authors.initials: SY
authors.lastname: Min
authors.affiliation: Department of Emergency Medicine, Chonnam National University Hospital, Gwangju.
authors.forename: Dong Hun
authors.initials: DH
authors.lastname: Lee
authors.affiliation: Department of Emergency Medicine, Chonnam National University Hospital, Gwangju.
authors.forename: Byung Kook
authors.initials: BK
authors.lastname: Lee
authors.affiliation: Department of Emergency Medicine, Chonnam National University Hospital, Gwangju.
authors.forename: Kyung Woon
authors.initials: KW
authors.lastname: Jeung
authors.affiliation: Department of Emergency Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea.
authors.forename: Hui Jai
authors.initials: HJ
authors.lastname: Lee
authors.affiliation: Department of Emergency Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea.
authors.forename: Jonghwan
authors.initials: J
authors.lastname: Shin
authors.affiliation: Department of Emergency Medicine, Ulsan University College of Medicine, Asan Medical Center, Seoul, Korea.
authors.forename: Byuk Sung
authors.initials: BS
authors.lastname: Ko
authors.affiliation: Department of Emergency Medicine, Ulsan University College of Medicine, Asan Medical Center, Seoul, Korea.
authors.forename: Shin
authors.initials: S
authors.lastname: Ahn
authors.affiliation: Department of Internal Medicine, Ulsan University College of Medicine, Asan Medical Center, Seoul, Korea.
authors.forename: Gi-Byoung
authors.initials: GB
authors.lastname: Nam
authors.affiliation: Department of Emergency Medicine, Ulsan University College of Medicine, Asan Medical Center, Seoul, Korea.
authors.forename: Kyoung Soo
authors.initials: KS
authors.lastname: Lim
authors.affiliation: Department of Emergency Medicine, Ulsan University College of Medicine, Asan Medical Center, Seoul, Korea. Electronic address: wonpia73@naver.com.
authors.forename: Won Young
authors.initials: WY
authors.lastname: Kim
mesh_terms: D000368:Aged; D019540:Area Under Curve; D001281:Atrial Fibrillation / Q000175:diagnosis* / Q000209:etiology; D016887:Cardiopulmonary Resuscitation; D002533:Cerebral Angiography; D017023:Coronary Angiography; D004562:Electrocardiography; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D058687:Out-of-Hospital Cardiac Arrest / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D018579:Patient Selection; D011237:Predictive Value of Tests; D012372:ROC Curve; D012042:Registries; D056910:Republic of Korea; D012189:Retrospective Studies; D000072657:ST Elevation Myocardial Infarction / Q000150:complications / Q000175:diagnosis* / Q000503:physiopathology; D013345:Subarachnoid Hemorrhage / Q000000981:diagnostic imaging / Q000209:etiology; D062606:Tertiary Care Centers; D013997:Time Factors; D016896:Treatment Outcome
keywords: cardiac arrest; electrocardiogram; myocardial infarction; resuscitation; subarachnoid hemorrhage