Utility of prehospital electrocardiogram characteristics as prognostic markers in out-of-hospital pulseless electrical activity arrests

Abstract

NCT00394706; post-results.

ECG changes during resuscitation of patients with initial pulseless electrical activity are associated with return of spontaneous circulation

“…In three OHCA studies examining PEA characteristics, of which one was published more than 25 years ago and two more recently, similar initial heart rates but narrower initial QRS widths were found when compared to the results in our study [10][11][12][13]. None of these studies have examined the dynamics of the ECG-characteristics during ongoing ALS.…”

“…Previous studies on out of hospital cardiac arrest (OHCA) have reported conflicting results regarding the association between initial heart rate and QRS width and subsequent survival. While some studies report increased survival with higher heart rates and narrower QRS complexes, others report no such association [10][11][12][13]. An animal study on post-defibrillation PEA demonstrated increased likelihood of return of spontaneous circulation (ROSC) with higher initial heart rates and narrower QRS complexes [14].…”

ECG changes during resuscitation of patients with initial pulseless electrical activity are associated with return of spontaneous circulation

“…In three OHCA studies examining PEA characteristics, of which one was published more than 25 years ago and two more recently, similar initial heart rates but narrower initial QRS widths were found when compared to the results in our study [10][11][12][13]. None of these studies have examined the dynamics of the ECG-characteristics during ongoing ALS.…”

“…Previous studies on out of hospital cardiac arrest (OHCA) have reported conflicting results regarding the association between initial heart rate and QRS width and subsequent survival. While some studies report increased survival with higher heart rates and narrower QRS complexes, others report no such association [10][11][12][13]. An animal study on post-defibrillation PEA demonstrated increased likelihood of return of spontaneous circulation (ROSC) with higher initial heart rates and narrower QRS complexes [14].…”

Cessation of Resuscitation in Pulseless Electrical Activity Out of Hospital Cardiac Arrest: A Mixed Methods Study of Senior Paramedic Decision Making

“…(25) In this study, 44% of patients progressed to a shockable rhythm and 16% achieved ROSC, albeit intermittent. Previous studies found progression to a shockable rhythm (26,27) and ROSC (6,7) increased the chance of survivability. This result suggests senior paramedics ceased resuscitation in patients with known factors which prognosticate survival.…”

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

“…Electrocardiogram (ECG) morphology was well considered with the majority of patients reporting a heart rate below 50 bpm (n = 46, 92%). A slow heart rate is widely accepted as a poor prognostic marker for survival [23], however, one study found morphology inaccurate to predict patient outcome [24]. A slow wide morphology indicates no cardiac movement, often categorised as a true PEA.…”

ECG changes during resuscitation of patients with initial pulseless electrical activity are associated with return of spontaneous circulation

“…In three OHCA studies examining PEA characteristics, of which one was published more than 25 years ago and two more recently, similar initial heart rates but narrower initial QRS widths were found when compared to the results in our study [10][11][12][13]. None of these studies have examined the dynamics of the ECG-characteristics during ongoing ALS.…”

“…Previous studies on out of hospital cardiac arrest (OHCA) have reported conflicting results regarding the association between initial heart rate and QRS width and subsequent survival. While some studies report increased survival with higher heart rates and narrower QRS complexes, others report no such association [10][11][12][13]. An animal study on post-defibrillation PEA demonstrated increased likelihood of return of spontaneous circulation (ROSC) with higher initial heart rates and narrower QRS complexes [14].…”

Cessation of Resuscitation in Pulseless Electrical Activity Out of Hospital Cardiac Arrest: A Mixed Methods Study of Senior Paramedic Decision Making

“…(25) In this study, 44% of patients progressed to a shockable rhythm and 16% achieved ROSC, albeit intermittent. Previous studies found progression to a shockable rhythm (26,27) and ROSC (6,7) increased the chance of survivability. This result suggests senior paramedics ceased resuscitation in patients with known factors which prognosticate survival.…”

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

“…Electrocardiogram (ECG) morphology was well considered with the majority of patients reporting a heart rate below 50 bpm (n = 46, 92%). A slow heart rate is widely accepted as a poor prognostic marker for survival [23], however, one study found morphology inaccurate to predict patient outcome [24]. A slow wide morphology indicates no cardiac movement, often categorised as a true PEA.…”

ECG changes during resuscitation of patients with initial pulseless electrical activity are associated with return of spontaneous circulation

“…In three OHCA studies examining PEA characteristics, of which one was published more than 25 years ago and two more recently, similar initial heart rates but narrower initial QRS widths were found when compared to the results in our study [10][11][12][13]. None of these studies have examined the dynamics of the ECG-characteristics during ongoing ALS.…”

“…Previous studies on out of hospital cardiac arrest (OHCA) have reported conflicting results regarding the association between initial heart rate and QRS width and subsequent survival. While some studies report increased survival with higher heart rates and narrower QRS complexes, others report no such association [10][11][12][13]. An animal study on post-defibrillation PEA demonstrated increased likelihood of return of spontaneous circulation (ROSC) with higher initial heart rates and narrower QRS complexes [14].…”

Cessation of Resuscitation in Pulseless Electrical Activity Out of Hospital Cardiac Arrest: A Mixed Methods Study of Senior Paramedic Decision Making

“…(25) In this study, 44% of patients progressed to a shockable rhythm and 16% achieved ROSC, albeit intermittent. Previous studies found progression to a shockable rhythm (26,27) and ROSC (6,7) increased the chance of survivability. This result suggests senior paramedics ceased resuscitation in patients with known factors which prognosticate survival.…”

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

“…Electrocardiogram (ECG) morphology was well considered with the majority of patients reporting a heart rate below 50 bpm (n = 46, 92%). A slow heart rate is widely accepted as a poor prognostic marker for survival [23], however, one study found morphology inaccurate to predict patient outcome [24]. A slow wide morphology indicates no cardiac movement, often categorised as a true PEA.…”