ROSC: does the ECG rule out OMI? And why does a heart just stop beating? And what rhythm is this?

This study had afatal flaw: they did not keep track of all the Non-STEMI patients who were NOT enrolled, but instead were sent for immediate angiogram.  It was done in Europe, where the guidelines suggest taking all shockable arrests emergently to the cath lab.  So it is highly likely that physicians were very reluctant to enroll patients; they did not want them to be randomized to no angiogram.  This strong suspicion is supported by their data:only 22 of 437 (5.0%) patients in this study had OMI.What percent of shockable arrests without STE have an OMI?  This large registry in Circulation 2010 reported that at least 1 significant coronary artery lesion was found in 128 (96%) of 134 patients with ST-segment elevation on the ECG performed after the return of spontaneous circulation, and in176 (58%) of 301 patients without ST-segment elevation. 5% vs. 58%!!  So there is definitely enrollment bias.The etiology of arrest innon-shockable rhythms is much less likely to be OMI (I don't know the exact number here).  Even though most OMI causes VT/VF, when the ischemia is overwhelming, such as in Left Main occlusion or near-occlusion, the heart may just stop beating.Seeing no other etiology than OMI, and knowing that the only chance for survival was to find and open a coronary artery, I activated the cath lab.He was taken to angiogram in a very unstable condition on an epinephrine drip.  The angiogram showed:LM: 90%LAD: ...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs

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