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
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Article info
Publication history
Published online: October 16, 2021
Accepted:
October 7,
2021
Received in revised form:
October 6,
2021
Received:
September 23,
2021
Identification
Copyright
© 2021 Elsevier B.V. All rights reserved.