Change in out-of-hospital 12-lead ECG diagnostic classification following resuscitation from cardiac arrest

Tom P Aufderheide; Thomas W Engel 2nd; Hadi O Saleh; David D Gutterman; Benjamin W Weston; Paul E Pepe; John E Baker; Jacob Labinski; Guillaume Debaty; Lujia Tang; Aniko Szabo; Rajat Kalra; Demetris Yannopoulos; M Riccardo Colella

doi:10.1016/j.resuscitation.2021.10.012

Change in out-of-hospital 12-lead ECG diagnostic classification following resuscitation from cardiac arrest

Resuscitation. 2021 Dec:169:45-52. doi: 10.1016/j.resuscitation.2021.10.012. Epub 2021 Oct 16.

Authors

Affiliations

¹ Department of Emergency Medicine, Medical College of Wisconsin, Milwaukee, WI, USA. Electronic address: [email protected].
² Department of Emergency Medicine, Medical College of Wisconsin, Milwaukee, WI, USA; Division of EMS Medicine, Department of Emergency Medicine, Medical College of Wisconsin, Milwaukee, WI, USA. Electronic address: [email protected].
³ Department of Emergency Medicine, Medical College of Wisconsin, Milwaukee, WI, USA. Electronic address: [email protected].
⁴ Division of Cardiovascular Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA; Department of Pharmacology and Toxicology, Medical College of Wisconsin, Milwaukee, WI, USA; The Cardiovascular Center, Medical College of Wisconsin, Milwaukee, WI, USA. Electronic address: [email protected].
⁵ Department of Emergency Medicine, Medical College of Wisconsin, Milwaukee, WI, USA; Division of EMS Medicine, Department of Emergency Medicine, Medical College of Wisconsin, Milwaukee, WI, USA. Electronic address: [email protected].
⁶ Dallas County Emergency Medical Services and County Public Safety Agencies, Dallas, TX, USA. Electronic address: [email protected].
⁷ Division of Congenital Heart Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA; Department of Biochemistry, Medical College of Wisconsin, Milwaukee, WI, USA; Department of Pharmacology and Toxicology, Medical College of Wisconsin, Milwaukee, WI, USA; Radiation Biosciences Laboratory, Medical College of Wisconsin, Milwaukee, WI, USA. Electronic address: [email protected].
⁸ Department of Emergency Medicine, Medical College of Wisconsin, Milwaukee, WI, USA. Electronic address: [email protected].
⁹ Department of Emergency Medicine, University Hospital of Grenoble Alps, University Grenoble Alps, France. Electronic address: [email protected].
¹⁰ International Research Fellow, Department of Emergency Medicine, Medical College of Wisconsin, Milwaukee, WI, USA. Electronic address: [email protected].
¹¹ Division of Biostatistics, Medical College of Wisconsin, Milwaukee, WI, USA. Electronic address: [email protected].
¹² Division of Cardiology, Department of Medicine, University of Minnesota School of Medicine, Minneapolis, MN, USA. Electronic address: [email protected].
¹³ Division of Cardiology, Department of Medicine, University of Minnesota School of Medicine, Minneapolis, MN, USA. Electronic address: [email protected].
¹⁴ Department of Emergency Medicine, Medical College of Wisconsin, Milwaukee, WI, USA; Division of EMS Medicine, Department of Emergency Medicine, Medical College of Wisconsin, Milwaukee, WI, USA. Electronic address: [email protected].

PMID: 34666124
DOI: 10.1016/j.resuscitation.2021.10.012

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.

Keywords: 12-lead electrocardiogram; Acute myocardial infarction; Cardiac arrest; Emergency medical services; Out-of-hospital; Resuscitation.

MeSH terms

Adolescent
Adult
Aged
Electrocardiography
Emergency Medical Services*
Hospitals
Humans
Male
Middle Aged
Out-of-Hospital Cardiac Arrest* / diagnosis
Out-of-Hospital Cardiac Arrest* / therapy
Reproducibility of Results
Retrospective Studies