Key result
Increasing heart rate and decreasing QRS complex width during advanced life support were significantly associated with return of spontaneous circulation, with HR increasing 3-6 min before ROSC.
Why the study?
ECG characteristics during advanced life support in cardiac arrest with initial PEA have been linked to prognosis but their development during resuscitation and association with survival needed examination.
Observational (n=74)
No
Increasing heart rate and narrowing QRS width during advanced life support for PEA cardiac arrest are associated with a higher likelihood of achieving return of spontaneous circulation.
ECG changes during CPR in initial PEA arrest were associated with survival; leaves open whether real-time monitoring should guide ALS.
BACKGROUND: Pulseless electrical activity (PEA) is a frequent initial rhythm in cardiac arrest, and ECG characteristics have been linked to prognosis. The aim of this study was to examine the development of ECG characteristics during advanced life support (ALS) and cardiopulmonary resuscitation (CPR) in cardiac arrest with initial PEA, and to assess any association with survival. METHODS: Patients with in-hospital cardiac arrest with initial PEA at St. Olav Hospital (Trondheim, Norway) over a three-year period were included. A total of 2187 combined observations of QRS complex rate (heart rate) and QRS complex width for the duration of ALS were determined from defibrillator recordings from 74 episodes of cardiac arrest. RESULTS: Increasing heart rate and decreasing QRS complex width during ALS was significantly more prevalent in patients who obtained return of spontaneous circulation compared to patients who were declared dead. CONCLUSION: Changes in ECG characteristics during ALS in cardiac arrest presenting as PEA are related to prognosis. An increase in heart rate was observed in the last 3-6 min before ROSC was obtained.
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Skjeflo et al. (2018) conducted an observational in In-hospital cardiac arrest with initial pulseless electrical activity (n=74). Changes in ECG characteristics (increasing heart rate and decreasing QRS width) vs. Patients declared dead (no ROSC) was evaluated on Return of spontaneous circulation (ROSC). Increasing heart rate and decreasing QRS complex width during advanced life support were significantly associated with return of spontaneous circulation, with HR increasing 3-6 min before ROSC.
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