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This month’s update comes from authors from the Trainee Emergency Research Network. We used a multimodal search strategy that drew on free open-access medical education resources and literature searches. We reviewed all papers published between 15 January 2022 and 15 February 2022. We identified the five most interesting and relevant papers (decided by consensus) and highlight the main findings, key limitations and clinical bottom line for each paper.
The papers are placed into one of three categories, allowing you to assess those which are most relevant to your practice:
Worth a peek—interesting, but not yet ready for prime time.
Head turner—new concepts.
Game changer—this paper could/should change practice.
Interobserver variability among experienced electrocardiogram readers to diagnose acute thrombotic coronary occlusion in patients with out of hospital cardiac arrest: impact of metabolic milieu and angiographic culprit by Sharma et al
Topic: cardiac arrest
Rating: head turner
The role and timing of invasive coronary angiography (ICA) is still debated, with the decision to go to ICA after ROSC usually predicated on reading of the post-arrest ECG. This single-centre retrospective study examined the performance of post-arrest ECG in predicting acute thrombotic coronary occlusion (ATCO). Patients with consecutive OHCA with ROSC with an initial shockable rhythm who underwent ICA during their index hospitalisation were included. Immediate post-arrest ECGs were reviewed by two experts and compared with angiographic data. Criteria included classic ST-elevation myocardial infarction (STEMI) findings and then an expanded definition including Sgarbossa criteria, ST-elevation in aVR and ischaemic changes diagnostic of posterior infarction. Among 152 patients undergoing ICA, 42% had ATCO on angiography. Classic STEMI criteria had a sensitivity of 50% and specificity of 98%; these values were 69% and 88%, respectively, when expanded criteria were applied. Test characteristics were worse in patients with abnormal metabolic milieu (significant acidaemia, lactataemia or hyperkalaemia/hypokalaemia). Interobserver agreement was modest (0.7 for STEMI criteria and 0.66 for combined criteria). Limitations of this study were a small sample size, retrospective design, performed at a single centre, and …
Twitter @Lucie_Cocker, @hirstposition
Contributors RC, RA, HC, LMC, MC, CW, RH surveyed the literature and produced the research summaries. RH was responsible for organisation, editing and submission of this document.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Provenance and peer review Not commissioned; internally peer reviewed.