Out-Of-Hospital Cardiac Arrest Clinical Trial
Official title:
Post-ROSC Electrocardiogram After Cardiac arrEst
PEACE study retrospectively evaluate patients who suffered an out-hospital cardiac arrest (OHCA) and who underwent a coronary angiography, enrolled in the registry of the Province of Pavia (Italy), Ticino Region (Switzerland), Wien region (Austria) and Nicosia area (Cyprus) to comprehend the best timing for post-ROSC ECG acquisition in order to reduce the number of false positive and to select the best candidates for emergency coronary angiography.
Twelve leads electrocardiogram (ECG) represents an essential step of the diagnostic workflow
after ROSC as stated by both the European and the American guidelines. Actually about 80% of
patients showing an ST segment elevation after return of spontaneous circulation (ROSC) have
a coronary lesion documented by coronary angiography. In those patients, early coronary
angiography has been shown to improve survival with good neurologic outcome. More
controversial is the scene for patients without an ST segment elevation. Even in the absence
of ST segment elevation an acute coronary syndrome can be at the basis of cardiac arrest.
However, the prognostic role of early coronary angiography in such patients is still a matter
of debate. In 2014 a consensus document by the European Association for Percutaneous
Cardiovascular Interventions (EAPCI) recommended elevation to consider early coronary
angiography only in the case of hemodynamic instability or of recurrent ventricular
arrhythmias for patients without ST segment as in the case of NSTEMI patients without cardiac
arrest. At the light of these considerations the correct diagnosis of ST segment elevation is
of pivotal importance for the right treatment in the right time and in the right hospital for
this type of patients. Moreover, during cardiac arrest and during resuscitation the heart is
suffering of ischemia deriving both from a coronary occlusion if present and from low
systemic perfusion. Post-ROSC ECG could reflect both these types of ischemia, so the ST
elevation could be not specific for a coronary occlusion. However, some time after ROSC, in
case of absence of a coronary occlusion, the heart perfusion should improve, the ischemia
should decrease and the ST segment elevation should regress. Nevertheless, current guidelines
do not provide any indication about the best timing for ECG acquisition after ROSC. We
believe that address this issue could be important in order to correctly discriminate the
appropriate candidate for emergency coronary angiography in the post-ROSC phase of a cardiac
arrest.
A preliminary analysis performed on a population of patients suffering an OHCA in the
Province of Pavia supported this hypothesis. It was pointed out that early detection of ST
segment elevation, within ten minutes from ROSC, was associated to a high number of false
positives that is to say patients without an identifiable coronary culprit lesion. ST segment
elevation was found to be an independent predictor of coronary angioplasty only if detected
after ten minutes from ROSC.
The PEACE study aimed to confirm our preliminary results on a larger and multicentric sample
of post ROSC patients.
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