Abstract
Survival after in-hospital cardiac arrest (I-HCA) remains < 30 %. There is very limited literature exploring the electrocardiogram changes prior to I-HCA. The purpose of the study was to determine demographics and electrocardiographic predictors prior to I-HCA. A retrospective study was conducted among 39 cardiovascular subjects who had cardiopulmonary resuscitation from I-HCA with initial rhythms of pulseless electrical activity (PEA) and asystole. Demographics including medical history, ejection fraction, laboratory values, and medications were examined. Electrocardiogram (ECG) parameters from telemetry were studied to identify changes in heart rate, QRS duration and morphology, and time of occurrence and location of ST segment changes prior to I-HCA. Increased age was significantly associated with failure to survive to discharge (p < 0.05). Significant change was observed in heart rate including a downtrend of heart rate within 15 min prior to I-HCA (p < 0.05). There was a significant difference in heart rate and QRS duration during the last hour prior to I-HCA compared to the previous hours (p < 0.05). Inferior ECG leads showed the most significant changes in QRS morphology and ST segments prior to I-HCA (p < 0.05). Subjects with an initial rhythm of asystole demonstrated significantly greater ECG changes including QRS morphology and ST segment changes compared to the subjects with initial rhythms of PEA (p < 0.05). Diagnostic ECG trends can be identified prior to I-HCA due to PEA and asystole and can be further utilized for training a predictive machine learning model for I-HCA.
Highlights
In-hospital cardiac arrest (I-HCA) accounts for approximately 200,000 cardiac arrests in the United States each year [1] and survival to discharge after cardiopulmonary resuscitation is less than 30 % [2]
A retrospective study was conducted among 39 cardiovascular subjects who had cardiopulmonary resuscitation from in-hospital cardiac arrest (I-HCA) with initial rhythms of pulseless electrical activity (PEA) and asystole
70 % of initial rhythms in patients with I-HCA are pulseless electrical activity (PEA) and asystole, and these rhythms are associated with higher mortality rates as compared to initial rhythms of ventricular tachycardia and fibrillation [4,5,6]
Summary
In-hospital cardiac arrest (I-HCA) accounts for approximately 200,000 cardiac arrests in the United States each year [1] and survival to discharge after cardiopulmonary resuscitation is less than 30 % [2]. Overall predictors of poor survival among hospitalized subjects with I-HCA include age, metastatic malignancy, impaired renal function and dependent functional status [3]. It is not clear whether I-HCA patients with known heart diseases have similar survival predictors. Identifying ECG changes prior to PEA and asystole in patients with known heart diseases may provide diagnostic clues that will lead to prevention or more timely treatments of I-HCA in such cases. Our study was designed to determine whether ECG indicator(s) may predict I-HCA due to PEA or asystole in patients with cardiovascular diseases, which might be used to shorten response time and improve treatment to increase the likelihood of successful resuscitation and discharge from the hospital
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