Highlights
- •Patient in cardiac arrest can have a different electrical rhythm by ECG and myocardial activity by echo.
- •Patients with PEA on ECG can have different activity by echo.
- •Patients with non-shockable rhythms by ECG can show shockable rhythms by echo.
Abstract
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.
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).
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. Survival 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).
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.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to ResuscitationAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Heart Disease and Stroke Statistics-2019 Update: A Report From the American Heart Association.Circulation. 2019; 139: e56-e528
- Regional Variation in Out-of-Hospital Cardiac Arrest Survival in the United States.Circulation. 2016; 133: 2159-2168
- Rapid cardiac ultrasound of inpatients suffering PEA arrest performed by nonexpert sonographers.Resuscitation. 2005; 67: 81-87
- The use of bedside ultrasound in cardiac arrest.Cal J Emerg Med. 2007; 8: 47-50
- Outcome in cardiac arrest patients found to have cardiac standstill on the bedside emergency department echocardiogram.Acad Emerg Med. 2001; 8: 616-621
- Does the presence or absence of sonographically identified cardiac activity predict resuscitation outcomes of cardiac arrest patients?.Am J Emerg Med. 2005; 23: 459-462
- Can cardiac sonography and capnography be used independently and in combination to predict resuscitation outcomes?.Acad Emerg Med. 2001; 8: 610-615
- Emergency department point-of-care ultrasound in out-of-hospital and in-ED cardiac arrest.Resuscitation. 2016; 109: 33-39
- Benefits of cardiac sonography performed by a non-expert sonographer in patients with non-traumatic cardiopulmonary arrest.Resuscitation. 2016; 102: 105-109
- Detection of Acute Pulmonary Embolism by Bedside Ultrasound in a Patient Presenting in PEA Arrest: A Case Report.Case Rep Emerg Med. 2012; 2012794019
- Emergency echocardiography to detect pericardial effusion in patients in PEA and near-PEA states.Resuscitation. 2003; 59: 315-318
- Emergency department focused bedside echocardiography in massive pulmonary embolism.J Emerg Med. 2011; 41: 658-660
- Survival after Cardiac Arrest Secondary to Massive Pulmonary Embolism.Case Rep Emerg Med. 2018; 2018: 8076808
- Sonography in Hypotension and Cardiac Arrest (SHoC): Rates of Abnormal Findings in Undifferentiated Hypotension and During Cardiac Arrest as a Basis for Consensus on a Hierarchical Point of Care Ultrasound Protocol.Cureus. 2016; 8: e564
- The REDCap consortium: Building an international community of software platform partners.J Biomed Inform. 2019; 95103208
- Research electronic data capture (REDCap)–a metadata-driven methodology and workflow process for providing translational research informatics support.J Biomed Inform. 2009; 42: 377-381
- Evaluation of out-of-hospital cardiac arrest using transesophageal echocardiography in the emergency department.Resuscitation. 2019; 137: 140-147
- A retrospective study of pulseless electrical activity, bedside ultrasound identifies interventions during resuscitation associated with improved survival to hospital admission. A REASON Study.Resuscitation. 2017; 120: 103-107
- Adult Advanced Life Support: 2020 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations.Circulation. 2020; 142: S92-S139
- Ultrasound use during cardiopulmonary resuscitation is associated with delays in chest compressions.Resuscitation. 2017; 119: 95-98
- Point-of-care ultrasound use in patients with cardiac arrest is associated prolonged cardiopulmonary resuscitation pauses: A prospective cohort study.Resuscitation. 2018; 122: 65-68
- Echocardiographic pre-pause imaging and identifying the acoustic window during CPR, reduces CPR pause time during ACLS - a prospective cohort study.Resuscit Plus. 2021; 6: 100094https://doi.org/10.1016/j.resplu.2021.100094
Article info
Publication history
Published online: November 15, 2021
Accepted:
September 7,
2021
Received in revised form:
September 3,
2021
Received:
June 9,
2021
Identification
Copyright
© 2021 Elsevier B.V. All rights reserved.
ScienceDirect
Access this article on ScienceDirectLinked Article
- Echocardiography during cardiac arrest: Time to incorporate into ACLS?ResuscitationVol. 169
- PreviewThe use of echocardiography (echo) during cardiac arrest has been widely adopted amongst emergency and critical care clinicians over the past 20 years.1 It is possible to obtain transthoracic cardiac images in nearly all arrest patients without prolonging compression pause time.2,3 In a consensus statement from 2010, the American Society of Echocardiography and the American College of Emergency Physicians recommended focused cardiac ultrasound to assess patients in cardiac arrest, specifically to differentiate between asystole, pulseless electrical activity (PEA) and pseudo-PEA, a state where no pulse is palpated yet the patient has organized ventricular contractions on echo.
- Full-Text
- Preview
