SAQ 358 – Cardiology – post-cardiac arrest hypotension and LBBB STEMI-equivalent

Cardiology – post-cardiac arrest hypotension and LBBB STEMI-equivalent.

a. Causes

• Cardiogenic shock, including post-arrest myocardial dysfunction.
• Hypovolaemia or haemorrhage.
• Obstructive shock, such as tamponade or pneumothorax after CPR.
• SIRS/distributive shock or anaphylaxis.

b. Post-arrest priorities

• Prevent recurrent cardiac arrest with airway, oxygenation, ventilation, and haemodynamic support.
• Define and treat the underlying cause using ECG, bedside echo, bloods, imaging, and targeted therapy.
• Limit organ damage with controlled oxygenation/ventilation, perfusion targets, temperature management, and seizure/glucose management.
• Arrange ICU/cardiology input and early coronary reperfusion when indicated.
• Plan neuroprognostication at an appropriate time rather than making early unsupported prognostic decisions.

c. ECG

• Sinus rhythm around 70/min, left axis deviation, and LBBB.
• Positive modified Sgarbossa criterion with concordant ST depression in V2-V3.
• This is a STEMI-equivalent pattern and may benefit from PCI.

d. Trial

• AIRWAYS-2: multicentre cluster RCT of 9269 patients.
• Supraglottic airway had higher initial ventilation success.
• Supraglottic airway and endotracheal tube had similar favourable neurological outcome at 30 days.
• No advanced airway had better outcomes than SGA or ETT, possibly confounded by proximity to ED.