Change in out-of-hospital 12-lead ECG diagnostic classification following resuscitation from cardiac arrest. Resuscitation 2021 Dec;169:45-52
Date
10/20/2021Pubmed ID
34666124DOI
10.1016/j.resuscitation.2021.10.012Scopus ID
2-s2.0-85118490179 (requires institutional sign-in at Scopus site) 1 CitationAbstract
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.
Author List
Aufderheide TP, Engel TW 2nd, Saleh HO, Gutterman DD, Weston BW, Pepe PE, Baker JE, Labinski J, Debaty G, Tang L, Szabo A, Kalra R, Yannopoulos D, Colella MRAuthors
John E. Baker PhD Professor in the Surgery department at Medical College of WisconsinMario R. Colella DO, MPH Professor in the Emergency Medicine department at Medical College of Wisconsin
Thomas W. Engel MD Assistant Professor in the Emergency Medicine department at Medical College of Wisconsin
Aniko Szabo PhD Professor in the Data Science Institute department at Medical College of Wisconsin
Benjamin Weston MD, MPH Associate Professor in the Emergency Medicine department at Medical College of Wisconsin
MESH terms used to index this publication - Major topics in bold
AdolescentAdult
Aged
Electrocardiography
Emergency Medical Services
Hospitals
Humans
Male
Middle Aged
Out-of-Hospital Cardiac Arrest
Reproducibility of Results
Retrospective Studies
