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 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
- Strategies to improve survival from cardiac arrest: a report from the institute of medicine.JAMA. 2015 Jul 21; 314: 223-224
- 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
- Part 8: Post-Cardiac Arrest Care: 2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care.Circulation. 2015; 132: S465-S482
- 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
- Immediate coronary angiography in survivors of out-of-hospital cardiac arrest.N Engl J Med. 1997; 336: 1629-1633
- 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
- Thrombosis and acute coronary-artery lesions in sudden cardiac ischemic death.N Engl J Med. 1984; 310: 1137-1140
- Impact of routine percutaneous coronary intervention after out-of-hospital cardiac arrest due to ventricular fibrillation.Critical Care. 2011; 15: R122
- 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
- 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
- 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
- Predictive value of electrocardiogram in diagnosing acute coronary artery lesions among patients with out-of-hospital-cardiac-arrest.Resuscitation. 2013 Sep; 84: 1250-1254
- Electrocardiographic changes simulating myocardial ischemia and infarction associated with spontaneous intracranial hemorrhage.Circulation. 1960; 22: 25-38
- 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
- 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
- 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
- Statistical Methods for Rates and Proportions.2nd ed. John Wiley & Sons Inc, New York1981
- 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
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.
