Heart rate and QRS duration as biomarkers predict the immediate outcome from pulseless electrical activity

A Norvik; J T Kvaløy; G W Skjeflo; D Bergum; T Nordseth; J P Loennechen; E Unneland; D G Buckler; A Bhardwaj; T Eftestøl; E Aramendi; B S Abella; E Skogvoll

doi:10.1016/j.resuscitation.2023.109739

Heart rate and QRS duration as biomarkers predict the immediate outcome from pulseless electrical activity

Resuscitation. 2023 Apr:185:109739. doi: 10.1016/j.resuscitation.2023.109739. Epub 2023 Feb 16.

Authors

A Norvik¹, J T Kvaløy², G W Skjeflo³, D Bergum⁴, T Nordseth¹, J P Loennechen⁵, E Unneland⁶, D G Buckler⁷, A Bhardwaj⁸, T Eftestøl⁹, E Aramendi¹⁰, B S Abella¹¹, E Skogvoll¹

Affiliations

¹ Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway; Department of Anesthesia and Intensive Care Medicine, St Olav University Hospital, Trondheim, Norway.
² Department of Mathematics and Physics, University of Stavanger, Stavanger, Norway.
³ Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway; Department of Surgery, Section for Anesthesiology, Nordland Hospital, Bodø, Norway.
⁴ Department of Anesthesia and Intensive Care Medicine, St Olav University Hospital, Trondheim, Norway.
⁵ Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway; Clinic of Cardiology, St. Olav University Hospital, Trondheim, Norway.
⁶ Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.
⁷ Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, NY, USA.
⁸ Department of Pulmonary and Critical Care Medicine, Cleveland Clinic Foundation, Cleveland, OH, USA.
⁹ Department of Electrical Engineering and Computer Science, University of Stavanger, Stavanger, Norway.
¹⁰ University of the Basque Country, Engineering School of Bilbao, Bilbao, Spain.
¹¹ Center for Resuscitation Science, University of Pennsylvania, Philadelphia, USA.

PMID: 36806651
DOI: 10.1016/j.resuscitation.2023.109739

Abstract

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 immediateoutcome during resuscitation from PEA. These universally available and promising biomarkers may guide the emergency team in tailoring individual treatment.

Keywords: ECG; In-hospital cardiac arrest; Prognostics; Pulseless electrical activity.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Biomarkers
Cardiopulmonary Resuscitation*
Heart Arrest* / therapy
Heart Rate
Hospitals
Humans

Substances

Biomarkers