Heart rate and QRS duration as biomarkers predict the immediate outcome from pulseless electrical activity
Norvik, Anders; Kvaløy, Jan Terje; Skjeflo, Gunnar Waage; Bergum, Daniel; Nordseth, Trond; Loennechen, Jan Pål; Unneland, Eirik; Buckler, D.G.; Bhardwaj, A.; Eftestøl, Trygve Christian; Aramendi, E.; Abella, BS.; Skogvoll, Eirik
Peer reviewed, Journal article
Published version
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https://hdl.handle.net/11250/3127038Utgivelsesdato
2023Metadata
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Originalversjon
Norvik, A., Kvaløy, J. T., Skjeflo, G. W., Bergum, D., Nordseth, T., Loennechen, J. P., ... & Skogvoll, E. (2023). Heart rate and QRS duration as biomarkers predict the immediate outcome from pulseless electrical activity. Resuscitation, 185, 109739. 10.1016/j.resuscitation.2023.109739Sammendrag
Introduction
Pulseless electrical activity (PEA) is commonly observed in in-hospital cardiac arrest (IHCA). Universally available ECG characteristics such as QRS duration (QRSd) and heart rate (HR) may develop differently in patients who obtain ROSC or not. The aim of this study was to assess prospectively how QRSd and HR as biomarkers predict the immediate outcome of patients with PEA.
Method
We investigated 327 episodes of IHCA in 298 patients at two US and one Norwegian hospital. We assessed the ECG in 559 segments of PEA nested within episodes, measuring QRSd and HR during pauses of compressions, and noted the clinical state that immediately followed PEA. We investigated the development of HR, QRSd, and transitions to ROSC or no-ROSC (VF/VT, asystole or death) in a joint longitudinal and competing risks statistical model.
Results
Higher HR, and a rising HR, reflect a higher transition intensity (“hazard”) to ROSC (p < 0.001), but HR was not associated with the transition intensity to no-ROSC. A lower QRSd and a shrinking QRSd reflect an increased transition intensity to ROSC (p = 0.023) and a reduced transition intensity to no-ROSC (p = 0.002).
Conclusion
HR and QRSd convey information of the immediate outcome during resuscitation from PEA. These universally available and promising biomarkers may guide the emergency team in tailoring individual treatment.