Abstract 18038: Morphology, Rate and Rhythm of Ventricular Complexes during Primary PEA and their Prognostic Significance
Introduction: Sudden cardiac arrest (SCA) with pulseless electrical activity (PEA) has a significantly lower survival rate compared to ventricular fibrillation and mechanisms of PEA are poorly understood.
Hypothesis: We hypothesized that there is significant variability in morphology, rate and rhythm of ventricular complexes recorded during PEA, with potential implications for resuscitation outcome.
Methods: In a pilot study from an ongoing community-based investigation of SCA in a metropolitan region of the US Pacific Northwest (2002 −2009), recordings of primary PEA were analyzed from 51 consecutive subjects that underwent resuscitation. Subjects were required to present with PEA as the initial rhythm. We measured morphology of the ventricular QRS complex as well as rate and rhythm of the RR interval.
Results: Overall mean R-R interval was 1697 ± 958 ms and the QRS duration was 194 ± 115 ms. Slow PEA (R-R > 1000 ms) was observed in 41 (80%) of the recordings, fast PEA (R-R < 600 ms) in 4 (8%) and normal R-R (600 – 1000 ms) PEA in 6 (12%). Wide complex PEA (QRS ≥ 120 ms) was found in 35 (69%) cases. Rhythm was irregular in 14 (27%). Fifteen cases (29%) had return of spontaneous circulation (ROSC) and 3 (6%) cases survived to hospital discharge (STHD). Among slow PEA, ROSC was reported in 11 (27%) and STHD in 2 (5%). Among PEA with normal R-R, ROSC was observed in 4 (67%) and STHD in one (17%). No patient with fast PEA had ROSC or STHD.
Conclusions: The majority of primary PEA presents with a slow rate <60 bpm and wide QRS complex. While further investigation is warranted in a larger study, fast PEA (rate>100) appears to have the worst prognosis.
- © 2010 by American Heart Association, Inc.