Abstract 12757: ECG Patterns in Early Pulseless Electrical Activity and the Etiologies of In-Hospital Cardiac Arrest
Introduction: The defibrillator is a mandatory diagnostic and therapeutic tool for the treatment of cardiac arrest (CA). The diagnostic potential of the defibrillator may not be fully utilized. Pulseless electrical activity (PEA) is increasingly common as the first presenting rhythm for a range of etiologies, in particular the ‘reversible causes 4H4T’ (figure). We investigated the etiology and its relation to the QRS duration and heart rate during PEA.
Method: We conducted a prospective observational study of all CA episodes treated by an in-hospital emergency team (ET) at St.Olav University Hospital in Trondheim/Norway during 4.5 years. Two cardiologists independently examined the ECG recorded during the first compression pause after attachment of the defibrillator, and measured the duration of three consecutive QRS complexes. The averaged QRS duration was defined as normal if shorter than 120ms and the heart rate (HR) was defined as normal if between 59 and 100/minute, leading to six simple ‘patterns’ of PEA: normal, wide, narrow-slow, wide-slow, narrow-fast and wide-fast. PEA episodes with reliable causes of arrest confirmed by objective diagnostic criteria were included.
Results: We identified 69 triggering causes in 51 PEA episodes. The figure shows the bivariate distribution of QRS/HR according to etiology, showing no obvious relationship.. In 48 episodes (83%) the initial ECGs were outside the ‘normal’ range regarding QRS duration, HR, or both. Six patients survived to hospital discharge, none of their presenting ECGs were ‘normal’
Conclusion: Four fifths of all presenting PEA patterns were found to be abnormal with respect to HR and QRS duration. An abnormal initial ECG did not point towards etiology nore precluded survival in this modest study sample.
Author Disclosures: D. Bergum: None. G.W. Skjeflo: None. J.P. Loennechen: None. O.C. Mjølstad: None. T. Nordseth: None. B.O. Haugen: None. E. Skogvoll: None.
- © 2015 by American Heart Association, Inc.