Interpretation of ECG after ROSC (Return of Spontaneous Circulation)

A standard 12-lead ECG should be recorded in all patients after return of spontaneous circulation (ROSC). The purpose of a 12-lead ECG is to detect ST-elevation myocardial infarction (STEMI). Stable patients with ROSC presenting with ST elevations should undergo urgent coronary angiography with the intent of performing PCI.

The COACT, PEARL and TOMAHAWK trials studied patients with ROSC who did not display ST segment elevations and randomized them to urgent angiography. These trials did not show any benefit of urgent angiography.

ST-elevation in acute transmural myocardial ischemia is discussed in the chapter ST-elevations in ischemia and differential diagnoses.

In cardiac arrest caused by acute total occlusion of an epicardial coronary artery (i.e. STEMI), pathological Q waves can develop already within 2 hours after the onset of infarction. The presence of such Q-waves should raise suspicion of ischemia/infarction as the underlying cause.

In cardiac arrest, non-specific ST-T changes are very common. Non-specific ST depressions, T-wave inversions (negative T-waves) do not affect the management of cardiac arrest.

Recurrent VT or VF after ROSC in a patient with a coronary risk profile should lead to consideration to perform early angiography.