Literature Review: Resolution of ST elevation on serial ECGs in post cardiac arrest patients

Emergency Cardiology Literature Review & Updates with Dr. Amal Mattu


A 64-year-old male is brought to the ED after cardiac arrest. He achieved ROSC after CPR, defibrillation, and epinephrine administration. A post ROSC ECG was immediately obtained by EMS and showed obvious ST segment elevation concerning for STEMI. The following ECG is obtained after arrival to the ED about 20 minutes later:

Before watching the video, ask yourself:

    1. How often do ED ECGs differ significantly from EMS obtained ECGs in post cardiac arrest patients?
    2. If a post cardiac arrest ECG demonstrates STEMI at any time, should the patient still go for cath even if the findings resolve? 
    3. Would you activate the cath lab?