Persistent Ventricular Fibrillation, ED ECMO, ED TEE, ROSC, Shark Fin ECG (also called " Giant R-wave " ), Postinfarction Regional Pericarditis. What a Case!

A 40-something suffered witnessed ventricular fibrillation, had bystander CPR, but could not be defibrillated after 4 attempts.He was transferred to the ED and put on extracorporeal life support (ECLS, ECMO).A series of ED Transesophageal echos (TEE) was done over 23 minutes before an ECG was recorded.  We usually do not get ROSC before angiography in these cases, and recording the ECG is not as important as usual, because we send them all to the cath lab by our ECMO protocol.This is before another defibrillation attempt, during chest compressions:Orientation:The probe is in the esophagus, right next to the left atrium.  so the chamber at the top of the image is the left atrium. Directly below that is the left ventricle.Flow on ECMO was successfully initiated.13 minutes later, the patient was successfully defibrillated. This was the immediate TEE:Minimal organized activity, and you can see good blood flow in the chamber due to ECMOAnother 4 minutes later:There is organized activity, but very slow and with poor contractilityAnother 6 minutes later (TEE with short axis):Contractility and heart rate are betterAn ECG was recorded:" Shark Fin "Diagnostic of Coronary Occlusion.I and aVL are involved, so this is a proximal LAD.Here are 2 more examples of Shark Fin on this blog.The patient was taken for immediate angiogram:Do you see the occlusion?Here I point it out with a red arrow:It was opened and stented:Excellent flowAn ECG was recorded after PCI:This appears to ...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs