Hypothermia at 18 Celsius in V Fib arrest: CPR, then ECMO rewarming, for 3 hours, then Defib with ROSC. Interpret the ECG.

A middle-aged man was found outside in the cold in full arrest in ventricular fibrillation.Chest compressions and ventilation were begun.On arrival, CPR was continued and core temperature was measured at 18 ° C (64.4° F).The patient was put on Extracorporeal Life Support in the ED3 hours after initial resuscitation, the core temp was 30 ° C and the patient was defibrillated with a single attempt.A 12-lead ECG was recorded:There is sinus rhythm with RBBB and right axis deviation.  In all leads, there is a 2nd wave after the initial QRS.  This is an Osborn wave.  I have not found any previous report of Osborn waves in RBBB.There is also profound ST depression maximal in V3.  Although in the context of chest pain such ST depression would be all but diagnostic of posterior OMI, one should make no conclusions in such an unusual case.This Transesophageal ED Echo was recorded:Cardiac POCUS.mov fromStephen Smith onVimeo.Guide to this image:30 minutes later, at 31 C, this ECG was recorded:The RBBB has resolved.  Osborn waves persistThe next day, this ECG was recorded at a normal temperature: Peak hs troponin I was 650 ng/LDay 1 echoECMO flow 2.9 L/min, arterial BP 106/81 mmHg, HR 92 bpm1. Estimated LVEF 25-30%, inferolateral abnormality possible Day 2 echoBaseline: ECMO flow 3.0 L/min, BP 107/65 mm Hg, HR 71 bpmLVEF45%, no wall motion abnormalityThe patient had a complete neurologic recovery, proving once again that the patient is not de...

Source: Dr. Smith's ECG Blog - February 8, 2022 Category: Cardiology Authors: Steve Smith Source Type: blogs