Abstract 370: Electrical Features Of Pulseless Electrical Activity Associated With Cardiac Arrest Outcomes

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_4) ◽  
Author(s):  
Steve Balian ◽  
David Alanis Garza ◽  
Mikel Leturiondo ◽  
Joshua R Lupton ◽  
James K Russell ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Electrical Activity ◽  
Frequency Spectrum ◽  
Prediction Models ◽  
Pulseless Electrical Activity ◽  
Median Frequency ◽  
Signal Power ◽  
Ecg Signals ◽  
Regression Methods ◽  
Band Pass

Introduction: The cardiac arrest rhythm of pulseless electrical activity (PEA) poses various diagnostic and therapeutic challenges. PEA may represent a spectrum of arrest conditions with variable responses to resuscitation care. Aim: We analyzed PEA rhythms to identify diagnostic patterns associated with survival in cardiac arrest. Methods: In this retrospective cohort study, we utilized the Portland Resuscitation Outcomes Consortium database of out-of-hospital cardiac arrests compiled by the Tualatin Valley Fire and Rescue from 2006-2016. Recordings from defibrillation pads included compression waveforms, electrocardiogram, and transthoracic impedance signals. For each patient, we analyzed the first two pauses in chest compressions, characterized by flat compression and impedance signals. Features extracted from raw ECG signals included contraction frequency and variability. Signal Fourier transformation and 0-100 Hz band pass filtering yielded signals’ distribution across a frequency spectrum from which signal power was extracted. Extraction of the three most prominent frequencies was performed from the Gaussian filtered frequency spectrum. Non-parametric tests (Mann-Whitney, Fisher) and logistic regression methods were used for analysis. Results: Fifty-nine ECG recordings were analyzed corresponding to 7 (11.9%) survivors and 52 (88.1%) non-survivors. Median age was 72 (IQR 20), and 28.8% (17/59) were female. No significant differences were noted in sex or median age between survivors and non-survivors. Analysis of the first ECG pause showed a higher first peak median frequency among survivors (2.15 vs 0.06 Hz, p=0.049). We did not find a significant association between the second peak median frequency of the first ECG segment (6.46 vs 1.49 Hz, p=0.882) or the signal power of the second ECG segment (108.04 vs 100.77 Hz, p=0.647) with survival. Regression analysis did not provide reliable outcome prediction models for survival in this preliminary cohort. Conclusion: Computerized analysis of PEA ECG waveforms offers alternate approaches to bedside signal interpretation that may correlate with survival. Our preliminary work offers a potential approach to PEA analysis that will require application to a larger PEA arrest cohort.

Abstract 052: Improved Hospital Outcomes With Hypokalemia on Admission in Cardiac Arrest Survivors Treated With Therapeutic Hypothermia

2017 ◽  
Vol 10 (suppl_3) ◽  
Author(s):  
Angelo de la Rosa ◽  
Manuel Tapia ◽  
Yong Ji ◽  
Basil Saour ◽  
Mikhail Torosoff
Keyword(s):  
Logistic Regression ◽  
Cardiac Arrest ◽  
Ventricular Fibrillation ◽  
Hospital Mortality ◽  
Electrical Activity ◽  
Therapeutic Hypothermia ◽  
Multivariate Logistic Regression Analysis ◽  
Pulseless Electrical Activity ◽  
Older Age ◽  
Chi Square

Purpose: We hypothesized that advanced circulatory compromise, as manifested by acidosis and hyperkalemia should be associated with worsened clinical outcomes in cardiac arrest patients treated with therapeutic hypothermia. Methods: Results of initial admission laboratory studies, medical history, and echocardiogram in 203 consecutive cardiac arrest patients (59 females, 59+/- 15 years old) undergoing therapeutic hypothermia were reviewed. Mortality was ascertained through hospital records. ANOVA, chi-square, Kaplan-Meier, and logistic regression analyses were used. The study was approved by the institutional IRB. Results: Increased mortality was noted with older age, decreased admission pH, elevated admission lactate, lower admission hemoglobin, and pulseless electrical activity or asystole as presenting rhythms (Table). Admission hypokalemia and ventricular fibrillation/tachycardia were associated with improved hospital mortality (Table). Potassium was significantly lower in patients admitted with ventricular fibrillation/tachycardia (3.897+/-0.92) as compared to patients with asystole (4.674+/-1.377) or pulseless electrical activity (4.491+/-1.055 mEq/dL, p<0.0001). In multivariate logistic regression analysis, independent predictors of increased hospital mortality included increased admission potassium (OR 2.0, 95%CI 1.291-3.170, p=0.002)), older age (OR 1.04, 95%CI 1.007-1.071, p=0.017), admission PEA (OR 3.7, 95%CI 1.358-10.282, p=0.011 when compared to ventricular fibrillation/tachycardia) or asystole (OR 17.2, 95%CI 4.423-66.810, p<0.001 when compared to ventricular fibrillation/tachycardia); while decreased mortality was associated with higher hemoglobin (OR 0.8, 95%CI 0.665-0.997, p=0.047). Conclusions: Hyperkalemia, pulseless electrical activity, and asystole are predictive of increased hospital mortality in survivors of cardiac arrest. An association between low or low-normal potassium, observed VT-VF, and better outcomes is unexpected and may be used for prognostic purposes. More prospective investigations of mortality predictors in these critically ill patients are needed.

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

Circulation ◽  
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 ◽  
Pulseless Electrical Activity ◽  
Qrs Complex ◽  
Epinephrine Administration ◽  
Hospital Cardiac Arrest

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.

scholarly journals How senior paramedics decide to cease resuscitation in pulseless electrical activity out of hospital cardiac arrest: a mixed methods study

2021 ◽  
Vol 29 (1) ◽  
Author(s):  
Ali Coppola ◽  
Sarah Black ◽  
Ruth Endacott
Keyword(s):  
Cardiac Arrest ◽  
Electrical Activity ◽  
Pulseless Electrical Activity ◽  
Structured Interview ◽  
Ambulance Service ◽  
Local Context ◽  
Clinical Judgement ◽  
Framework Analysis ◽  
Senior Clinician ◽  
The Impact

Abstract Background Evidenced-based guidelines on when to cease resuscitation for pulseless electrical activity are limited and support for paramedics typically defaults to the senior clinician. Senior clinicians include paramedics employed to work beyond the scope of clinical guidelines as there may be a point at which it is reasonable to cease resuscitation. To support these decisions, one ambulance service has applied a locally derived cessation of resuscitation checklist. This study aimed to describe the patient, clinical and system factors and examine senior clinician experiences when ceasing resuscitation for pulseless electrical activity. Design and methods An explanatory sequential mixed method study was conducted in one ambulance service in the South West of England. A consecutive sample of checklist data for adult pulseless electrical activity were retrieved from 1st December 2015 to 31st December 2018. Unexpected results which required exploration were identified and developed into semi-structured interview questions. A purposive sample of senior clinicians who ceased resuscitation and applied the checklist were interviewed. Content framework analysis was applied to the qualitative findings. Results Senior clinicians ceased resuscitation for 50 patients in the presence of factors known to optimise survival: Witnessed cardiac arrest (n = 37, 74%), bystander resuscitation (n = 30, 60%), defibrillation (n = 22, 44%), return of spontaneous circulation (n = 8, 16%). Significant association was found between witnessed cardiac arrest and bystander resuscitation (p = .00). Six senior clinicians were interviewed, and analysis resulted in four themes: defining resuscitation futility, the impact of ceasing resuscitation, conflicting views and clinical decision tools. In the local context, senior clinicians applied their clinical judgement to balance survivability. Multiple factors were considered as the decision to cease resuscitation was not always clear. Senior clinicians deviated from the checklist when the patient was perceived as non-survivable. Conclusion Senior clinicians applied clinical judgement to assess patients as non-survivable or when continued resuscitation was considered harmful with no patient benefit. Senior clinicians perceived pre-existing factors with duration of resuscitation and clinical factors known to optimise patient survival. Future practice could look beyond a set criteria in which to cease resuscitation, however, it would be helpful to investigate the value or threshold of factors associated with patient outcome.

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

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 ◽  
Pulseless Electrical Activity ◽  
Secondary Outcome ◽  
Qrs Complex ◽  
The Relationship ◽  
Hospital Cardiac Arrest

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.

Prolonged Pulseless Electrical Activity Cardiac Arrest After Intranasal Injection of Lidocaine With Epinephrine

2019 ◽  
Vol 12 (12) ◽  
pp. 438-440 ◽  
Author(s):  
Frank Weber ◽  
Rahul Guha ◽  
Guy Weinberg ◽  
Frank Steinbach ◽  
Marina Gitman
Keyword(s):  
Cardiac Arrest ◽  
Electrical Activity ◽  
Pulseless Electrical Activity
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