Change in out-of-hospital 12-lead ECG diagnostic classification following resuscitation from cardiac arrest. (December 2021)

• Record Type: Journal Article
• Authors: Aufderheide, Tom P.; Engel, Thomas W.; Saleh, Hadi O.; Gutterman, David D.; Weston, Benjamin W.; Pepe, Paul E.; Baker, John E.; Labinski, Jacob; Debaty, Guillaume; Tang, Lujia; Szabo, Aniko; Kalra, Rajat; Yannopoulos, Demetris; Colella, M. Riccardo
• Is Part Of: Resuscitation. Volume 169(2021)
• Page Start: 45
• Page End: 52
• Publication Date: 2021-12
• Subjects: Cardiac arrest -- 12-lead electrocardiogram -- Out-of-hospital -- Acute myocardial infarction -- Resuscitation -- Emergency medical services; Resuscitation -- Periodicals; Resuscitation -- Periodicals; Réanimation -- Périodiques; Electronic journals; 616.025
• DOI: 10.1016/j.resuscitation.2021.10.012
• Languages: English
• ISSNs: 0300-9572

Abstract

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.