Comparison of outcomes between pulseless electrical activity by electrocardiography and pulseless myocardial activity by echocardiography in out-of-hospital cardiac arrest; secondary analysis from a large, prospective study

Secondary Outcome ◽

Shockable Rhythm ◽

Cardiac Electrical Activity ◽

Objective: To measure prevalence of discordance between electrical activity recorded by electrocardiography (ECG) and myocardial activity visualized by echocardiography (echo) in patients presenting after cardiac arrest and to compare survival outcomes in cohorts defined by ECG and echo. Methods: This is a secondary analysis of a previously published prospective study at twenty hospitals. Patients presenting after out-of-hospital arrest were included. The cardiac electrical activity was defined by ECG and contemporaneous myocardial activity was defined by bedside echo. Myocardial activity by echo was classified as myocardial asystole- -the absence of myocardial movement, pulseless myocardial activity (PMA)--visible myocardial movement but no pulse, and myocardial fibrillation- -visualized fibrillation. Primary outcome was the prevalence of discordance between electrical activity and myocardial activity. Secondary outcome was survival to hospital discharge. Results: 793 patients and 1943 pauses in CPR were included. 28.6% of CPR pauses demonstrated a difference in electrical activity (ECG) and myocardial activity (echo), 5.0% with asystole (ECG) and PMA (echo), and 22.1% with PEA (ECG) and myocardial asystole (echo). Survival to hospital admission for patients with PMA (echo) was 29.1% (95%CI-23.9-34.9) compared to those with PEA (ECG) (21.4%, 95%CI-17.7-25.6). Twenty-five percent of the 32 pauses in CPR with a shockable rhythm by echo demonstrated a non-shockable rhythm by ECG and were not defibrillated. One of these patients survived, a patient with asystole on ECG and vfib by echo survived because vfib was identified on ECG during a subsequent pause and was defibrillated. Conclusion: Patients in cardiac arrest commonly demonstrate different electrical (ECG) and myocardial activity (echo). Further research is needed to better define cardiac activity during cardiac arrest and to explore outcome between groups defined by electrical and myocardial activity.

The association between end-tidal CO2 and return of spontaneous circulation after out-of-hospital cardiac arrest with pulseless electrical activity

Resuscitation ◽

10.1016/j.resuscitation.2021.08.014 ◽

2021 ◽

Vol 167 ◽

pp. 76-81

Author(s):

Michael Crickmer ◽

Ian R. Drennan ◽

Linda Turner ◽

Sheldon Cheskes

Keyword(s):

Cardiac Arrest ◽

Electrical Activity ◽

Spontaneous Circulation ◽

Return Of Spontaneous Circulation ◽

End Tidal ◽

Hospital Cardiac Arrest ◽

End Tidal Co2

Abstract 150: Impact of Epinephrine on ECG Changes During Resuscitation From Out-of-Hospital Cardiac Arrest With Initial Pulseless Electrical Activity

Circulation ◽

10.1161/circ.138.suppl_2.150 ◽

2018 ◽

Vol 138 (Suppl_2) ◽

Author(s):

Gunnar W Skjeflo ◽

Eirik Skogvoll ◽

Jan Pål Loennechen ◽

Theresa M Olasveengen ◽

Lars Wik ◽

...

Keyword(s):

Heart Rate ◽

Cardiac Arrest ◽

Electrical Activity ◽

Multivariate Regression ◽

Life Support ◽

Controlled Trial ◽

Qrs Complex ◽

Epinephrine Administration ◽

Introduction: Presence of electrocardiographic rhythm, documented by the electrocardiogram (ECG), in the absence of palpable pulses defines pulseless electrical activity (PEA). Our aims were to examine the development of ECG characteristics during advanced life support (ALS) from Out-of-Hospital-Cardiac-Arrest (OHCA) with initial PEA, and to explore the effects of epinephrine on these characteristics. Methods: Patients with OHCA and initial PEA in a randomized controlled trial of ALS with or without intravenous access and medications were included. QRS widths and heart-rates were measured in recorded ECG signals during pauses in compressions. Statistical analysis was carried out by multivariate regression (MANOVA). Results: Defibrillator recordings from 170 episodes of cardiac arrest were analyzed, 4840 combined measurements of QRS complex width and heart rate were made. By the multivariate regression model both whether epinephrine was administered and whether return of spontaneous circulation (ROSC) was obtained were significantly associated with changes in QRS width and heart rate. For both control and epinephrine groups, ROSC was preceded by decreasing QRS width and increasing rate, but in the epinephrine group an increase in rate without a decrease in QRS width was associated with poor outcome (fig). Conclusion: The QRS complex characteristics are affected by epinephrine administration during ALS, but still yields valuable prognostic information.

Quantitative Characterization of Left Ventricular Function During Pulseless Electrical Activity Using Echocardiography During Out-of-Hospital Cardiac Arrest

Resuscitation ◽

10.1016/j.resuscitation.2021.05.016 ◽

2021 ◽

Author(s):

Felipe Teran ◽

Norman A. Paradis ◽

Anthony J. Dean ◽

M. Kit Delgado ◽

Kristin A. Linn ◽

...

Keyword(s):

Cardiac Arrest ◽

Left Ventricular Function ◽

Electrical Activity ◽

Ventricular Function ◽

Left Ventricular ◽

Quantitative Characterization ◽

Conversion to shockable rhythms is associated with better outcomes in out-of-hospital cardiac arrest patients with initial asystole but not in those with pulseless electrical activity

Resuscitation ◽

10.1016/j.resuscitation.2016.08.008 ◽

2016 ◽

Vol 107 ◽

pp. 88-93 ◽

Cited By ~ 8

Author(s):

Ruiying Zheng ◽

Shengyuan Luo ◽

Jinli Liao ◽

Zhihao Liu ◽

Jia Xu ◽

...

Keyword(s):

Cardiac Arrest ◽

Electrical Activity ◽

QRS complex characteristics and patient outcomes in out-of-hospital pulseless electrical activity cardiac arrest

Emergency Medicine Journal ◽

10.1136/emermed-2020-209623 ◽

2020 ◽

Vol 38 (1) ◽

pp. 53-58

Author(s):

Jung Ho Kim ◽

Hyun Wook Ryoo ◽

Jong-yeon Kim ◽

Jae Yun Ahn ◽

Sungbae Moon ◽

...

Keyword(s):

Cardiac Arrest ◽

Electrical Activity ◽

Hospital Discharge ◽

Neurological Outcome ◽

Prospective Observational Study ◽

Secondary Outcome ◽

Qrs Complex ◽

The Relationship ◽

BackgroundPulseless electrical activity (PEA) is increasingly observed in out-of-hospital cardiac arrest (OHCA), but outcomes are still poor. We aimed to assess the relationship between QRS characteristics and outcomes of patients with OHCA with initial PEA (OHCA-P).MethodsThis prospective observational study included patients aged at least 18 years who developed OHCA-P between 1 January 2016 and 31 December 2018, and were enrolled in the Daegu Emergency Medical Services registry, South Korea. We performed multivariable logistic regression analyses to identify the associations between QRS characteristics and OHCA-P outcomes, in which QRS complexes were considered separately (model 1) and simultaneously (model 2). The primary outcome was survival to hospital discharge and the secondary outcome was a favourable neurological outcome.ResultsOf the 3659 patients with OHCA, 576 were enrolled (median age 73 years; 334 men). A higher QRS amplitude was associated with survival to hospital discharge and a favourable neurological outcome in model 1 (adjusted OR (aOR) 1.077 and 1.106, respectively; 95% CI 1.021 to 0.136 and 1.029 to 1.190, respectively) and model 2 (aOR 1.084 and 1.123, respectively; 95% CI 1.026 to 1.145 and 1.036 to 1.216, respectively). A QRS width of <120 ms was associated with survival to hospital discharge and a favourable neurological outcome in model 1 (aOR 3.371 and 4.634, respectively; 95% CI 1.633 to 6.960 and 1.562 to 13.144, respectively) and model 2 (aOR 3.213 and 5.103, respectively; 95% CI 1.568 to 6.584 and 1.682 to 15.482, respectively). Survival to hospital discharge and neurological outcome were not associated with QRS frequency.ConclusionOHCA-P outcomes were better when the initial QRS complex showed a higher amplitude or narrower width.

Validation of the Gothenburg Futility Criteria for Out-of-hospital Cardiac Arrest Presenting with Pulseless Electrical Activity

Academic Emergency Medicine ◽

10.1197/j.aem.2004.02.411 ◽

2004 ◽

Vol 11 (5) ◽

pp. 602-602

Author(s):

R. B. Abu-Laban

Keyword(s):

Cardiac Arrest ◽

Electrical Activity ◽

UK ambulance service resuscitation management of pulseless electrical activity: a systematic review protocol of text and opinion

British Paramedic Journal ◽

10.29045/14784726.2020.06.5.1.20 ◽

2020 ◽

Vol 5 (1) ◽

pp. 20-25

Author(s):

Alison Coppola ◽

Sarah Black ◽

Sasha Johnston ◽

Ruth Endacott

Keyword(s):

Systematic Review ◽

Cardiac Arrest ◽

Electrical Activity ◽

Life Support ◽

Guideline Implementation ◽

Ambulance Service ◽

Synthesis Process ◽

Reference List ◽

Background: Out-of-hospital cardiac arrest patients with pulseless electrical activity are treated by paramedics using basic and advanced life support resuscitation. When resuscitation fails to achieve return of spontaneous circulation, there are limited evidence and national guidelines on when to continue or stop resuscitation. This has led to ambulance services in the United Kingdom developing local guidelines to support paramedics in the resuscitative management of pulseless electrical activity. The content of each guideline is unknown, as is any association between guideline implementation and patient survival. We aim to identify and synthesise local ambulance service guidelines to help improve the consistency of paramedic-led decision-making for the resuscitation of pulseless electrical activity in out-of-hospital cardiac arrest.Methods: A systematic review of text and opinion will be conducted on ambulance service guidelines for resuscitating adult cardiac arrest patients with pulseless electrical activity. Data will be gathered direct from the ambulance service website. The review will be guided by the methods of the Joanna Briggs Institute (JBI). The search strategy will be conducted in three stages: 1) a website search of the 14 ambulance services; 2) a search of the evidence listed in support of the guideline; and 3) an examination of the reference list of documents found in the first and second stages and reported using the Preferred Reporting Items for Systematic Reviews and Meta-analyses. Each document will be assessed against the inclusion criteria, and quality of evidence will be assessed using the JBI Critical Appraisal Checklist for Text and Opinion. Data will be extracted using the JBI methods of textual data extraction and a three-stage data synthesis process: 1) extraction of opinion statements; 2) categorisation of statements according to similarity of meaning; and 3) meta-synthesis of statements to create a new collection of findings. Confidence of findings will be assessed using the graded ConQual approach.