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trauma
resuscitation
clinical skills
literature review

Influence of time on the predictive value of the post-resuscitation ECG

02 October 2021
Features
02 October 2021
Volume 13 · Issue 10

Abstract

Background:

The reliability of the electrocardiogram (ECG) after return of spontaneous circulation (ROSC) is unclear. While its predictive value has previously been described, no studies have looked at the influence of time on the post-ROSC ECG.

Aim:

This study aimed to evaluate the predictive value of the ECG immediately after ROSC and between 1 and 5 hours later to assess whether time influences its ability to accurately predict the need for percutaneous coronary intervention.

Methods:

A single-centre, retrospective, observational 1-year analysis examined the records of post-ROSC patients who underwent coronary angiography and for whom prehospital and delayed post-ROSC ECGs were available for analysis.

Findings:

Forty-two post-ROSC ECGs were reviewed alongside angiographic findings. Sensitivities of 25% and 69%, specificities of 60% and 100% and an accuracies of 33% and 76% were calculated for the prehospital and delayed hospital ECGs respectively. A chi-squared value of 7.78 (P=0.0053) suggests there is statistical significance between the two.

Conclusions:

The delayed post-ROSC ECG is statistically significantly more accurate, suggesting that time influences the reliability of the post-ROSC ECG.

Following the return of spontaneous circulation (ROSC) after a cardiac arrest, understanding the precipitating cause allows clinicians to provide definitive treatment for the patient (Nolan et al, 2017). As the majority of out-of-hospital cardiac arrests (OHCAs) are thought to be precipitated by coronary pathology, advanced life support guidelines suggest that a post-ROSC electrocardiogram (ECG) is obtained and interpreted.

A common post-ROSC ECG finding is ST elevation. This often indicates an underlying acute myocardial infarction (MI), which has been shown to benefit from immediate revascularisation via percutaneous coronary intervention (PCI) (Nolan et al, 2017).

Short contact-to-balloon times are associated with improved morbidity and mortality outcomes (Foo et al, 2018), which leads to pressure on prehospital clinicians to decide at an early stage on successful resuscitation whether the patient should be conveyed directly to the catheterisation laboratory to receive PCI or whether the patient should be conveyed to the emergency department (ED) for stabilisation, assessment and ongoing management (Nolan et al, 2017).

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Cardiac arrest
Advanced life support
Cardiopulmonary resuscitation (CPR)
Electrocardiogram (ECG)
EKG
Return of Spontaneous Circulation
Critical care
Cardiology