Abstract 14198: Changes in ECG Characteristics are Related to Prognosis and Etiology in Pulseless Electrical Activity
Introduction: Pulseless electrical activity (PEA) is a frequent initial rhythm in cardiac arrest. ECG characteristics have been linked to prognosis, and recognition of the cause of arrest may improve survival. The aim of this study was to examine to what extent changes in ECG characteristics observed during cardiopulmonary resuscitation (CPR) may be predictive of both the probable cause of arrest, and survival.
Methods: We analyzed QRS-complex width and heart rate in defibrillator recordings obtained during CPR efforts in 74 episodes of in-hospital cardiac arrest with initial PEA at St. Olav Hospital (Trondheim, Norway) between January 2009 and January 2012. A cardiac or non-cardiac etiology of arrest was determined in 63 of the 74 episodes included. We analyzed the resulting data using locally weighted regression scatterplot smoothing for the first 15 minutes of CPR. The primary outcome was return of spontaneous circulation (ROSC).
Results: Patients obtaining ROSC exhibited a steady increase in heart rate (approximately 5 beats/min. per min.) over the first 15 minutes (Figure). Development of QRS complex width was less clear, but an early QRS complex widening was observed among patients who did not obtain ROSC. Patients with a cardiac etiology differed from patients with a non-cardiac etiology; most notably by lacking an increase in heart rate in the patients obtaining ROSC.
Conclusion: A steady increase in heart rate during CPR is a positive prognostic sign in patients with cardiac arrest and initial PEA. Absence of such a response may prompt the rescuer to consider a cardiac etiology.
- Cardiac arrest
- Cardiopulmonary resuscitation
- Return of spontaneous circulation (ROSC)
Author Disclosures: G.W. Skjeflo: None. T. Nordseth: None. J. Loennechen: None. D. Bergum: None. E. Skogvoll: None.
- © 2016 by American Heart Association, Inc.