Advertisement
Clinical paper| Volume 169, P45-52, December 2021

Download started.

Ok

Change in out-of-hospital 12-lead ECG diagnostic classification following resuscitation from cardiac arrest

  • Tom P. Aufderheide
    Correspondence
    Corresponding author at: Department of Emergency Medicine, Medical College of Wisconsin, HUB for Collaborative Medicine, 3rd Floor, 8701 W. Watertown Plank Road, Milwaukee, WI 53226, USA.
    Affiliations
    Department of Emergency Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
    Search for articles by this author
  • Author Footnotes
    1 Co-authors.
    ,
    Author Footnotes
    2 Department of Emergency Medicine, Division of EMS Medicine, Medical College of Wisconsin, HUB for Collaborative Medicine, 3rd Floor, 8701 W. Watertown Plank Road, Milwaukee, WI 53226, USA.
    Thomas W. Engel II
    Footnotes
    1 Co-authors.
    2 Department of Emergency Medicine, Division of EMS Medicine, Medical College of Wisconsin, HUB for Collaborative Medicine, 3rd Floor, 8701 W. Watertown Plank Road, Milwaukee, WI 53226, USA.
    Affiliations
    Department of Emergency Medicine, Medical College of Wisconsin, Milwaukee, WI, USA

    Division of EMS Medicine, Department of Emergency Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
    Search for articles by this author
  • Author Footnotes
    1 Co-authors.
    ,
    Author Footnotes
    2 Department of Emergency Medicine, Division of EMS Medicine, Medical College of Wisconsin, HUB for Collaborative Medicine, 3rd Floor, 8701 W. Watertown Plank Road, Milwaukee, WI 53226, USA.
    Hadi O. Saleh
    Footnotes
    1 Co-authors.
    2 Department of Emergency Medicine, Division of EMS Medicine, Medical College of Wisconsin, HUB for Collaborative Medicine, 3rd Floor, 8701 W. Watertown Plank Road, Milwaukee, WI 53226, USA.
    Affiliations
    Department of Emergency Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
    Search for articles by this author
  • Author Footnotes
    1 Co-authors.
    ,
    Author Footnotes
    3 Cardiovascular Medicine, MCW – The Hub for Collaborative Medicine, 8701 Watertown Plank Road, 5th Floor, Milwaukee, WI 53226, USA.
    David D. Gutterman
    Footnotes
    1 Co-authors.
    3 Cardiovascular Medicine, MCW – The Hub for Collaborative Medicine, 8701 Watertown Plank Road, 5th Floor, Milwaukee, WI 53226, USA.
    Affiliations
    Division of Cardiovascular Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA

    Department of Pharmacology and Toxicology, Medical College of Wisconsin, Milwaukee, WI, USA

    The Cardiovascular Center, Medical College of Wisconsin, Milwaukee, WI, USA
    Search for articles by this author
  • Author Footnotes
    1 Co-authors.
    ,
    Author Footnotes
    2 Department of Emergency Medicine, Division of EMS Medicine, Medical College of Wisconsin, HUB for Collaborative Medicine, 3rd Floor, 8701 W. Watertown Plank Road, Milwaukee, WI 53226, USA.
    Benjamin W. Weston
    Footnotes
    1 Co-authors.
    2 Department of Emergency Medicine, Division of EMS Medicine, Medical College of Wisconsin, HUB for Collaborative Medicine, 3rd Floor, 8701 W. Watertown Plank Road, Milwaukee, WI 53226, USA.
    Affiliations
    Department of Emergency Medicine, Medical College of Wisconsin, Milwaukee, WI, USA

    Division of EMS Medicine, Department of Emergency Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
    Search for articles by this author
  • Author Footnotes
    1 Co-authors.
    ,
    Author Footnotes
    4 Emergency Medical Services and Public Safety, 11318 Dujon Lane, Dallas, TX 75218-1390, USA.
    Paul E. Pepe
    Footnotes
    1 Co-authors.
    4 Emergency Medical Services and Public Safety, 11318 Dujon Lane, Dallas, TX 75218-1390, USA.
    Affiliations
    Dallas County Emergency Medical Services and County Public Safety Agencies, Dallas, TX, USA
    Search for articles by this author
  • Author Footnotes
    1 Co-authors.
    ,
    Author Footnotes
    5 Department of Surgery (Congenital Heart Surgery), Biochemistry, Pharmacology & Toxicology, Radiation Biosciences Laboratory, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI 53226, USA.
    John E. Baker
    Footnotes
    1 Co-authors.
    5 Department of Surgery (Congenital Heart Surgery), Biochemistry, Pharmacology & Toxicology, Radiation Biosciences Laboratory, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI 53226, USA.
    Affiliations
    Division of Congenital Heart Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA

    Department of Biochemistry, Medical College of Wisconsin, Milwaukee, WI, USA

    Department of Pharmacology and Toxicology, Medical College of Wisconsin, Milwaukee, WI, USA

    Radiation Biosciences Laboratory, Medical College of Wisconsin, Milwaukee, WI, USA
    Search for articles by this author
  • Author Footnotes
    1 Co-authors.
    ,
    Author Footnotes
    2 Department of Emergency Medicine, Division of EMS Medicine, Medical College of Wisconsin, HUB for Collaborative Medicine, 3rd Floor, 8701 W. Watertown Plank Road, Milwaukee, WI 53226, USA.
    Jacob Labinski
    Footnotes
    1 Co-authors.
    2 Department of Emergency Medicine, Division of EMS Medicine, Medical College of Wisconsin, HUB for Collaborative Medicine, 3rd Floor, 8701 W. Watertown Plank Road, Milwaukee, WI 53226, USA.
    Affiliations
    Department of Emergency Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
    Search for articles by this author
  • Author Footnotes
    1 Co-authors.
    ,
    Author Footnotes
    6 Emergency Medical Services – Mobile Intensive Care Unit - SAMU 38, University Hospital of Grenoble Alps, CS 10217 – 38043 Grenoble Cedex 09, France.
    Guillaume Debaty
    Footnotes
    1 Co-authors.
    6 Emergency Medical Services – Mobile Intensive Care Unit - SAMU 38, University Hospital of Grenoble Alps, CS 10217 – 38043 Grenoble Cedex 09, France.
    Affiliations
    Department of Emergency Medicine, University Hospital of Grenoble Alps, University Grenoble Alps, France
    Search for articles by this author
  • Author Footnotes
    1 Co-authors.
    ,
    Author Footnotes
    2 Department of Emergency Medicine, Division of EMS Medicine, Medical College of Wisconsin, HUB for Collaborative Medicine, 3rd Floor, 8701 W. Watertown Plank Road, Milwaukee, WI 53226, USA.
    Lujia Tang
    Footnotes
    1 Co-authors.
    2 Department of Emergency Medicine, Division of EMS Medicine, Medical College of Wisconsin, HUB for Collaborative Medicine, 3rd Floor, 8701 W. Watertown Plank Road, Milwaukee, WI 53226, USA.
    Affiliations
    International Research Fellow, Department of Emergency Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
    Search for articles by this author
  • Author Footnotes
    1 Co-authors.
    ,
    Author Footnotes
    7 Division of Biostatistics, 8701 Watertown Plank Rd., Medical Education Building, MEB M1400, Milwaukee, WI 53226, USA.
    Aniko Szabo
    Footnotes
    1 Co-authors.
    7 Division of Biostatistics, 8701 Watertown Plank Rd., Medical Education Building, MEB M1400, Milwaukee, WI 53226, USA.
    Affiliations
    Division of Biostatistics, Medical College of Wisconsin, Milwaukee, WI, USA
    Search for articles by this author
  • Author Footnotes
    1 Co-authors.
    ,
    Author Footnotes
    8 Cardiovascular Division, University of Minnesota, 420 Delaware Street S.E., MMC 508, Minneapolis, MN 55455, USA.
    Rajat Kalra
    Footnotes
    1 Co-authors.
    8 Cardiovascular Division, University of Minnesota, 420 Delaware Street S.E., MMC 508, Minneapolis, MN 55455, USA.
    Affiliations
    Division of Cardiology, Department of Medicine, University of Minnesota School of Medicine, Minneapolis, MN, USA
    Search for articles by this author
  • Author Footnotes
    1 Co-authors.
    ,
    Author Footnotes
    8 Cardiovascular Division, University of Minnesota, 420 Delaware Street S.E., MMC 508, Minneapolis, MN 55455, USA.
    Demetris Yannopoulos
    Footnotes
    1 Co-authors.
    8 Cardiovascular Division, University of Minnesota, 420 Delaware Street S.E., MMC 508, Minneapolis, MN 55455, USA.
    Affiliations
    Division of Cardiology, Department of Medicine, University of Minnesota School of Medicine, Minneapolis, MN, USA
    Search for articles by this author
  • Author Footnotes
    1 Co-authors.
    ,
    Author Footnotes
    2 Department of Emergency Medicine, Division of EMS Medicine, Medical College of Wisconsin, HUB for Collaborative Medicine, 3rd Floor, 8701 W. Watertown Plank Road, Milwaukee, WI 53226, USA.
    M. Riccardo Colella
    Footnotes
    1 Co-authors.
    2 Department of Emergency Medicine, Division of EMS Medicine, Medical College of Wisconsin, HUB for Collaborative Medicine, 3rd Floor, 8701 W. Watertown Plank Road, Milwaukee, WI 53226, USA.
    Affiliations
    Department of Emergency Medicine, Medical College of Wisconsin, Milwaukee, WI, USA

    Division of EMS Medicine, Department of Emergency Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
    Search for articles by this author
  • Author Footnotes
    1 Co-authors.
    2 Department of Emergency Medicine, Division of EMS Medicine, Medical College of Wisconsin, HUB for Collaborative Medicine, 3rd Floor, 8701 W. Watertown Plank Road, Milwaukee, WI 53226, USA.
    3 Cardiovascular Medicine, MCW – The Hub for Collaborative Medicine, 8701 Watertown Plank Road, 5th Floor, Milwaukee, WI 53226, USA.
    4 Emergency Medical Services and Public Safety, 11318 Dujon Lane, Dallas, TX 75218-1390, USA.
    5 Department of Surgery (Congenital Heart Surgery), Biochemistry, Pharmacology & Toxicology, Radiation Biosciences Laboratory, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI 53226, USA.
    6 Emergency Medical Services – Mobile Intensive Care Unit - SAMU 38, University Hospital of Grenoble Alps, CS 10217 – 38043 Grenoble Cedex 09, France.
    7 Division of Biostatistics, 8701 Watertown Plank Rd., Medical Education Building, MEB M1400, Milwaukee, WI 53226, USA.
    8 Cardiovascular Division, University of Minnesota, 420 Delaware Street S.E., MMC 508, Minneapolis, MN 55455, USA.

      Abstract

      Introduction

      We evaluated the incidence of change in serial 12-lead electrocardiogram (ECG) diagnostic classifications in patients resuscitated from out-of-hospital (OH) cardiac arrest (OHCA) comparing OH to emergency department (ED) ECGs.

      Methods

      This retrospective case series included: 1) adults (≥ 18 years old), 2) resuscitated from OHCA, 3) ≥ 1 OH and 1 ED ECG/patient, and 4) emergency medical services (EMS) transport to the study hospital. OH and ED ECGs were classified as: 1) STEMI (ST-segment Elevation Myocardial Infarction), 2) Ischemic, and 3) Non-ischemic. Two ED physicians and one cardiologist independently classified all ECGs, then generated a consensus opinion classification for each ECG based on American Heart Association’s 2018 Expert Consensus criteria. The most ischemic OH ECG classification was compared with the last ED ECG classification.

      Results

      From 7/27/12 to 7/18/19, 176 patients were entered with a mean age of 61.2 ± 16.6 years; 102/176 (58%) were male. Overall, 504 OH and ED 12-lead ECGs were acquired (2.9 ECGs/patient). ECG classification inter-rater reliability kappa score was 0.63 ± 0.02 (substantial agreement). Overall, 86/176 (49%) changed ECG classification from the OH to ED setting; 69/86 (80%) of these ECGs changed from more to less ischemic classifications. Of 49 OH STEMI ECG classifications, 33/49 (67%) changed to a less ischemic (non-STEMI) ED ECG classification.

      Conclusions

      Change in 12-lead ECG classification from OH to ED setting in patients resuscitated from OHCA was common (49%). The OH STEMI classification changed to a less ischemic (non-STEMI) ED classification in 67% of cases.

      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 access
      One-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 Resuscitation
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Becker L.B.
        • Aufderheide T.P.
        • Graham R.
        Strategies to improve survival from cardiac arrest: a report from the institute of medicine.
        JAMA. 2015 Jul 21; 314: 223-224
        • Nolan Jerry P.
        • Soar Jasmeet
        • Cariou Alain
        • et al.
        European Resuscitation Council and European Society of Intensive Care Medicine Guidelines for Post-resuscitation Care 2015: Section 5 of the European Resuscitation Council Guidelines for Resuscitation 2015.
        Resuscitation. 2015; 95: 202-222
        • Callaway Clifton W.
        • Donnino Michael W.
        • Fink Ericka L.
        • et al.
        Part 8: Post-Cardiac Arrest Care: 2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care.
        Circulation. 2015; 132: S465-S482
        • Marco Valgimigli
        • Christoph Varenhorst
        • Pascal Vranckx
        • Petr Widimský
        • ESC Scientific Document Group
        ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: The Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC).
        Eur Heart J. 2018; 39: 119-177
        • Spaulding C.M.
        • Joly L.M.
        • Rosenberg A.
        • et al.
        Immediate coronary angiography in survivors of out-of-hospital cardiac arrest.
        N Engl J Med. 1997; 336: 1629-1633
        • Wagner H.
        • Terkelsen C.J.
        • Friberg H.
        • et al.
        Cardiac arrest in the catheterization laboratory: a 5-year experience of using mechanical chest compressions to facilitate PCI during prolonged resuscitation efforts.
        Resuscitation. 2010; 81: 3837
        • Davies M.J.
        • Thomas A.
        Thrombosis and acute coronary-artery lesions in sudden cardiac ischemic death.
        N Engl J Med. 1984; 310: 1137-1140
        • Cronier P.
        • Vignon P.
        • Bouferrache K.
        • et al.
        Impact of routine percutaneous coronary intervention after out-of-hospital cardiac arrest due to ventricular fibrillation.
        Critical Care. 2011; 15: R122
        • Noc M.
        • Fajadet J.
        • Lassen J.F.
        • et al.
        Invasive coronary treatment strategies for out-of-hospital cardiac arrest: a consensus statement from the European Association for Percutaneous Cardiovascular Interventions (EAPCI)/Stent for Life (SFL) groups.
        EuroIntervention: J EuroPCR Collaboration Working Group Interventional Cardiol Europ Soc Cardiol. 2014; 10: 31-37
        • Kern K.B.
        • Lotun K.
        • Patel N.
        • et al.
        Outcomes of comatose cardiac arrest survivors with and without ST-segment elevation myocardial infarction: importance of coronary angiography.
        JACC Cardiovascular Interventions. 2015; 8: 1031-1040
        • Zeliaś A.
        • Stępińska J.
        • Andres J.
        • Trąbka-Zawicki A.
        • Sadowski J.
        • Żmudka K.
        Ten-year experience of an invasive cardiology centre with out-of-hospital cardiac arrest patients admitted for urgent coronary angiography.
        Kardiol Pol. 2014; 72: 687-699
        • Zanuttini D.
        • Armellini I.
        • Nucifora G.
        • et al.
        Predictive value of electrocardiogram in diagnosing acute coronary artery lesions among patients with out-of-hospital-cardiac-arrest.
        Resuscitation. 2013 Sep; 84: 1250-1254
        • Cropp G.J.
        • Manning G.W.
        Electrocardiographic changes simulating myocardial ischemia and infarction associated with spontaneous intracranial hemorrhage.
        Circulation. 1960; 22: 25-38
        • Nam Julian
        • Caners Kyla
        • Bowen James M.
        • Welsford Michelle
        • O'Reilly Daria
        Systematic review and meta-analysis of the benefits of out-of-hospital 12-lead ECG and advance notification in ST-segment elevation myocardial infarction patients.
        Ann Emerg Med. 2014; 64 (186.e1-9): 176-186
        • Thygesen K.
        • Alpert J.S.
        • Jaffe A.S.
        • et al.
        Executive Group on behalf of the Joint European Society of Cardiology (ESC)/American College of Cardiology (ACC)/American Heart Association (AHA)/World Heart Federation (WHF) Task Force for the Universal Definition of Myocardial Infarction. Fourth Universal Definition of Myocardial Infarction (2018).
        J Am Coll Cardiol. 2018; 72: 2231-2264
        • Baldi E.
        • Schnaubelt S.
        • Caputo M.L.
        • et al.
        Association of Timing of Electrocardiogram Acquisition After Return of Spontaneous Circulation With Coronary Angiography Findings in Patients With Out-of-Hospital Cardiac Arrest.
        JAMA Netw Open. 2021 Jan 4; 4e2032875
        • Fleiss J.L.
        Statistical Methods for Rates and Proportions.
        2nd ed. John Wiley & Sons Inc, New York1981
        • Tateishi K.
        • Abe D.
        • Iwama T.
        • Hamabe Y.
        • Aonuma K.
        • Sato A.
        Clinical value of ST-segment change after return of spontaneous cardiac arrest and emergent coronary angiography in patients with out-of-hospital cardiac arrest: Diagnostic and therapeutic importance of vasospastic angina.
        Eur Heart J Acute Cardiovasc Care. 2018 Aug; 7: 405-413