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Massive ST segment elevation on ECG (so called 'shark fin' pattern, see below) is indicative of severe myocardial injury and is associated with increased risk of ventricular arrhythmia, cardiogenic shock, and death.

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This study suggests that high-dose nitroglycerin infusion may be a safe alternative to intermittent bolus dosing for SCAPE, but prospective trials are needed to determine optimal initial rates and titration strategies, as well as the proper use of other adjunct therapies.

Source
High-dose nitroglycerin infusion description of safety and efficacy in sympathetic crashing acute pulmonary edema: The HI-DOSE SCAPE study. Am J Emerg Med. 2022 Oct 18;63:74-78. doi: 10.1016/j.ajem.2022.10.018. Epub ahead of print.

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For in-hospital ventricular fibrillation/ventricular tachycardia (VF/VT) arrest (IHCA), lidocaine may have more favorable outcomes compared to amiodarone.

Source
Comparative Effectiveness of Amiodarone and Lidocaine for Treatment of In-Hospital Cardiac Arrest (IHCA). Chest. 2022 Nov 1;S0012-3692(22)04039-9. doi: 10.1016/j.chest.2022.10.024. Online ahead of print.

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Here are the latest evidence updates on basic, advanced, and pediatric life support - and more - from this expert literature review.

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2022 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations: Summary From the Basic Life Support; Advanced Life Support; Pediatric Life Support; Neonatal Life Support; Education, Implementation, and Teams; and First Aid Task Forces. Circulation. 2022 Nov 3. doi: 10.1161/CIR.0000000000001095. Online ahead of print.

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Empiric calcium administration in PEA arrest not only failed to improve ROSC, but also had no impact when ECG features of hyperkalemia and acute myocardial ischemia were present.

Source
Effect of Calcium in Patients with Pulseless Electrical Activity and Electrocardiographic Characteristics Potentially Associated with Hyperkalemia and Ischemia-Sub-study of the Calcium for Out-of-hospital Cardiac Arrest (COCA) trial. Resuscitation. 2022 Nov 17;S0300-9572(22)00712-2. doi: 10.1016/j.resuscitation.2022.11.006. Online ahead of print.

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No patients with a high sensitivity troponin (hsTn) < 99^th percentile of upper reference limit (URL) - drawn 6 hours after symptom onset - had death, arrest, STEMI, or life-threatening arrhythmia; 3 had NSTEMI.

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High sensitivity troponin - Six hours is the magic number. Am J Emerg Med. 2022 Nov;61:52-55. doi: 10.1016/j.ajem.2022.08.037. Epub 2022 Aug 19.

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For the treatment of refractory ventricular fibrillation (VF) in out-of-hospital cardiac arrest, survival to hospital discharge was more common among patients who received double sequential external defibrillation (DSED) and vector-change (VC) defibrillation than those who received standard defibrillation. 

Source
Defibrillation Strategies for Refractory Ventricular Fibrillation. N Engl J Med. 2022 Nov 6. doi: 10.1056/NEJMoa2207304. Online ahead of print.

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Rhythm control, compared to rate control, was associated with reduced mortality and cardiovascular risk in low-risk patients with atrial fibrillation.

Source
Early Rhythm Control Therapy for Atrial Fibrillation in Low-Risk Patients : A Nationwide Propensity Score-Weighted Study. Ann Intern Med. 2022 Sep 6. doi: 10.7326/M21-4798. Online ahead of print.

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Placing transcutaneous cardiac pacer pads in the anteroposterior position required less energy to successfully capture. 

Source
Anteroposterior Pacer Pad Position Is More Likely to Capture Than Anterolateral for Transcutaneous Cardiac Pacing. Circulation. 2022;146(14):1103-1104. doi:10.1161/CIRCULATIONAHA.122.060735 

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Biphasic or deep precordial T waves on ECG can occur with spontaneous reperfusion of an occluded left anterior descending artery and should not be ignored in the patient with chest pain.

Source
Wellens' Syndrome. N Engl J Med. 2022 Sep 22;387(12):e25. doi: 10.1056/NEJMicm2201699.