Underlying Pathology

It will be necessary to consider the type of arrest, and any pre-hospital clinical context or history that can be obtained.

Ventricular fibrillation (VF)/ventricular tachycardia (VT) can occur as part of acute coronary syndrome, as a primary arrhythmia, due to electrolyte disturbance, poisoning, or electrocution. Pulseless electrical activity (PEA) often occurs post-pulmonary embolus or secondary to hypovolaemia or hypoxia.

The CT pulmonary angiogram shows a large pulmonary embolus. Click on the CT to enlarge.

Percutaneous coronary intervention (PCI) should be considered in all post-arrest patients in whom an acute myocardial infarction (AMI) is strongly suspected regardless of the presence or absence of ST segment elevation of ROSC ECG. A study by Elfwen, et al. found that short and long-term survival rates were improved in those receiving early coronary angiography where OHCA was witnessed and the patient had a shockable rhythm, but where no ST-elevation was demonstrated on the ECG. [4,8,9]