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Hyperacute T-waves, when defined by an absolute amplitude threshold greater than the 95th percentile, were not helpful in diagnosing myocardial infarction.
Source
Hyperacute T Wave in the Early Diagnosis of Acute Myocardial Infarction. Ann Emerg Med. 2023 Feb 9:S0196-0644(22)01327-0. doi: 10.1016/j.annemergmed.2022.12.003. Epub ahead of print.
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New evidence has demonstrated that previous dogma to withhold nitrates from patients with right ventricular myocardial infarction (RVMI) may be incorrect.
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High sensitivity cardiac troponins (hs-cTn) can be more complex to interpret than our usual diagnostics and are worth a deep dive to understand. This article does an incredible job summarizing existing guidelines and data about how to utilize hs-cTn clinically.Â
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Patients with STEMI or STEMI equivalent who were treated within goal treatment times had significantly lower in-hospital mortality.
Source
Treatment time and In-Hospital Mortality Among Patients with ST-Segment Elevation Myocardial Infarction, 2018-2021. JAMA. 2022 Nov 22; 328(20): 2033-2040.
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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) < 99th percentile of upper reference limit (URL) – drawn 6 hours after symptom onset – had death, arrest, STEMI, or life-threatening arrhythmia; 3 had NSTEMI.
Source
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.
