Abstract 16491: ECG Rhythm Identification and Subsequent CPR Quality Among Responders to In-Hospital Cardiac Arrest
Introduction: Presenting electrocardiogram (ECG) rhythm is an important predictor of neurologically intact survival from cardiac arrest and directs both intra- and post-arrest treatment. However, identification of presenting ECG is done by the first attending provider and communicated independent of provider expertise or post-event confirmation. We examined the accuracy of ECG identification and its association with CPR quality following in-hospital cardiac arrest (IHCA). We hypothesized that initial ECG would be frequently misclassified as non-shockable and associated with poor quality CPR.
Methods: This study is a retrospective, observational, single center investigation of consecutive patients experiencing IHCA with attempted resuscitation between March 6, 2015 and September 25, 2015. ECG and CPR process data were compared to written records of resuscitation. Responding provider ECG impression (shockable vs non-shockable) was compared to two experts’ interpretations of the first 6 seconds of ECG data. Disagreement was adjudicated by a third expert. Chest compression fraction (CCF) and compression rates were compared using two-tailed t-test.
Results: 61 subjects were enrolled in the study. Subjects were predominately male, with a mean age of 58.4 years. IHCA occurred off hours 80% of the time, with 54% achieving return of spontaneous circulation (ROSC). When compared with expert interpretation, responding providers were accurate 88% of time with moderate inter-rater reliability (kappa = 0.67). Experts had excellent inter-rater reliability (k = 0.96, 1 case adjudicated). All seven misclassified cases were deemed non-shockable by providers, 5 of which occurred during off-hours and only 3 achieved ROSC. There was no significant difference in mean CCF or compression rate when ECG rhythm was deemed shockable vs. non-shockable (70.09% vs 76.83%, p=.347; 126.27 vs. 122.18 compressions/min p= .273, respectively).
Conclusions: This single center, pilot investigation indicates a significant number initial ECG rhythm maybe misclassified as non-shockable.
Author Disclosures: M. Beidleman: None. K. Sawyer: None. T. Camp-Rogers: None. M.C. Kurz: None.
- © 2016 by American Heart Association, Inc.