Abstracts / Resuscitation 130S (2018) e28–e145 e125 AP223 Post-ROSC twelve-leads electrocardiogram. Everything in its time Simone Savastano 1,∗ , Enrico Baldi 1 , Elisa Cacciatore 1 , Simone Molinari 2 , Fabrizio Canevari 2 , Francesco Zerba 1 , Stefano Buratti 1 , Maurizio Ferrario 1 , Alessandra Palo 2 , Gaetano Maria De Ferrari 3 , Luigi Oltrona Visconti 1 1 Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy 2 AAT 118 Pavia AREU Lombardia, Pavia, Italy 3 Intensive Coronary Care Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy Purpose: International guidelines recommend to perform a 12- leads electrocardiogram (ECG) after the return of spontaneous circulation (ROSC) and to perform an emergent coronary angiogram at least in those patients presenting with ST segment elevation. However, the best timing for the acquisition of the ECG after ROSC has never been assessed. Methods: We considered for analysis all patients enrolled in the Pavia CARe (out-of-hospital cardiac arrests registry of the province of Pavia) from January 2015 to December 2017 for whom a post-ROSC ECG and a coronary angiography were retrospectively available. Every ECG was blindly reviewed and then categorized as positive or negative for STEMI according to the latest edition of the universal definition of myocardial infarction. Results: Among the 1403 resuscitation attempts in the study period, 149 patients arrived alive to our hub Hospital. In 139 of them a post-ROSC ECG was available and in 89 a coronary angiog- raphy was also performed. The median time interval from ROSC to ECG was 8 min (interquartile range 4.8–16 min); 45 (32%) ECGs were negative for STEMI and 94 (68%) were positive for STEMI. The time for acquisition of the ECG was a predictors for positive ECG [OR 0.97 (95%CI 0.97–0.99) p = 0.01] and a cut-off time of less than 10 min was associated to the best sensitivity/specificity for positive ECG (AUC 0.65 p = 0.02). Therefore having a positive ECG in the first 10 min after ROSC was not a predictor of coronary intervention [OR 2.9 (95%CI 0.7–11.9) p = 0.14], whereas showing a positive ECG after 10 min after ROSC was a strong predictor of coronary intervention [OR 12.6 (95%CI 2.5–64.3) p = 0.002]. Conclusions: Post-ROSC 12-lead ECG is an essential step in the diagnostic flow after cardiac arrest, however its acquisition too early could increase the number of false positives. https://doi.org/10.1016/j.resuscitation.2018.07.265 AP224 Post ROSC Perfusion Index and survival after out-of-hospital cardiac arrest. An update of our results Simone Savastano 1,∗ , Enrico Baldi 1 , Elisa Cacciatore 1 , Giulia Bellini 1 , Fabrizio Canevari 2 , Alessandra Palo 2 , Giorgio Iotti 3 , Gaetano Maria De Ferrari 4 , Luigi Oltrona Visconti 1 1 Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy 2 AAT 118 Pavia AREU Lombardia, Pavia, Italy 3 Intensive Care Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy 4 Intensive Coronary Care Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy Purpose: Prognostication after out of hospital cardiac arrest (OHCA) is still now an open issue. About this topic we have explored, for the first time, the potential role of the post ROSC peripheral perfusion index as a predictor of 30 days survival. Our aim was to confirm our preliminary results on a larger population. Materials and methods: We retrospectively evaluated the reports generated by the manual monitor/defibrillator (Corpuls by GS Elektromedizinische Geräte G. Stemple GmbH, Germany) used for cases of OHCA in which ROSC was achieved, from January 2015 to December 2017. The mean values of PI were automatically pro- vided in the report every minute after ROSC and the mean value of 30 min of monitoring (MPI 30 ) was calculated. The duration of cardiac arrest, the type of presenting rhythm (shockable or not shockable) and the total amount of epinephrine administered were also computed. Results: On 2246 OHCA enrolled in our provincial cardiac arrest registry (Pavia CARe) a resuscitation was attempted in 1403 cases and a ROSC was achieved in 241. The mean value of PI during 30 min of monitoring (MPI 30 ) after ROSC was available in 124 patients. Survived patients showed significantly higher values of MPI 30 [1.4 (95%CI 0.9–2.7) vs. 1 (95%CI 0.8–1.3) p = 0.02]. At multivariable Cox regression model MPI 30 was an independent predictor of death at 30 days [HR 0.8 (95%CI 0.6–0.98) p = 0.036]. Moreover, patients with value of MPI30 ≥ 2.5 showed a better 30 days survival [HR 2.1 (95%CI 1.2–3.6) p = 0.017]. An inverse correlation was found between the total amount of epinephrine administered corrected for the duration of cardiac arrest and the MPI 30 (Spearman’s Rho -0.3 p < .01). Conclusions: Our results confirmed on a larger population the potential role of peripheral perfusion index as a predictor of 30 days survival after an OHCA. https://doi.org/10.1016/j.resuscitation.2018.07.266 AP225 Changes of surface body temperatures after local cooling in survivors of cardiac arrest during the maintenance phase of TTM Andrej Markota 1,2,∗ , Kristijan Skok 2 , Sandra Burja 2 , Jernej Mori 1 , Andreja Sinkoviˇ c 1,2 1 Medical Intensive Care Unit, University Medical Centre Maribor, Maribor, Slovenia 2 Faculty of Medicine, University of Maribor, Maribor, Slovenia Purpose: To determine changes in surface body temperatures after local cooling of different regions in comatose adult survivors