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. 2025 Apr:209:110567.
doi: 10.1016/j.resuscitation.2025.110567. Epub 2025 Mar 6.

Associations with resolution of ST-segment elevation myocardial infarction criteria on out-of-hospital 12-lead electrocardiograms following resuscitation from cardiac arrest

Christopher J Naas  1 , Hadi O Saleh  2 , Thomas W Engel 2nd  3 , David D Gutterman  4 , Aniko Szabo  5 , Thomas Grawey  6 , Benjamin W Weston  7 , Christopher E Monti  8 , John E Baker  9 , Jacob Labinski  10 , Lujia Tang  11 , Jamie Jasti  12 , Jason A Bartos  13 , Rajat Kalra  14 , Demetris Yannopoulos  15 , M Riccardo Colella  16 , Tom P Aufderheide  17
Affiliations

Associations with resolution of ST-segment elevation myocardial infarction criteria on out-of-hospital 12-lead electrocardiograms following resuscitation from cardiac arrest

Christopher J Naas et al. Resuscitation. 2025 Apr.

Abstract

Introduction: A previous study found that following out-of-hospital cardiac arrest (OHCA), 67% of out-of-hospital 12-lead electrocardiograms (ECGs) diagnostic for ST-segment elevation myocardial infarction (STEMI) changed to non-STEMI on repeat emergency department (ED) ECG. Here we evaluated associations with resolution of STEMI on ED ECG.

Methods: In this secondary analysis of a previous retrospective study, adults (≥18 years) with return of spontaneous circulation (ROSC) following OHCA, at least 1 out-of-hospital and ED ECG and transport to the study hospital were entered. We analyzed variables suspected of influencing ischemic changes on ECG including arrest characteristics, treatment interventions, resuscitation duration, and out-of-hospital and ED ECG acquisition times.

Results: Forty-nine of 176 patients entered had out-of-hospital ECGs diagnostic for STEMI, and 33/49 (67%) had resolved STEMI upon ED evaluation. Shorter resuscitation time (13 [interquartile range 5-18] vs 21 [14-28] minutes), p = 0.007), less epinephrine (3 [1-4] vs 5 [2-10] milligrams, p = 0.018), lower incidence of norepinephrine (5/33 (15%) vs 11/16 (69%), p ≤ 0.001), less time from ROSC to out-of-hospital ECG acquisition (5.5 [1-8] vs 8.5 [7-14] minutes, p = 0.044), and more time between out-of-hospital and ED ECG acquisition (34 [25-52] vs 21 [14-27] minutes, p = 0.001) were associated with resolution of out-of-hospital STEMI on ED evaluation. More defibrillations were associated with increased ischemia on ED ECG for patients with non-STEMI out-of-hospital ECGs.

Conclusion: ROSC patients with STEMI on out-of-hospital ECG commonly resolve in the ED (67%). These identified associations may better inform clinical decision making. Post-ROSC out-of-hospital 12-lead ECGs should be repeated on arrival in the ED.

Keywords: 12-lead electrocardiogram; Acute myocardial infarction; Cardiac arrest; Out-of-hospital; Resuscitation.

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Conflict of interest statement

Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: “Tom P. Aufderheide is on the editorial board of Resuscitation and reports a relationship with National Heart Lung and Blood Institute that includes: funding grants. Tom P. Aufderheide reports a relationship with National Institute of Neurological Disorders and Stroke that includes: funding grants. Tom P. Aufderheide reports a relationship with ZOLL Medical Corporation that includes: funding grants. Tom P. Aufderheide reports a relationship with Cytovale Inc that includes: funding grants. Tom P. Aufderheide reports a relationship with Inflammatix, Inc. that includes: funding grants. Tom P. Aufderheide reports a relationship with Abbott Laboratories that includes: funding grants. Tom P. Aufderheide reports a relationship with MeMed that includes: funding grants. Tom P. Aufderheide reports a relationship with AstraZeneca Pharmaceuticals LP that includes: funding grants. Tom P. Aufderheide reports a relationship with Medtronic Inc that includes: consulting or advisory. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.”.

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