Comparison of outcomes between pulseless electrical activity by electrocardiography and pulseless myocardial activity by echocardiography in out-of-hospital cardiac arrest; secondary analysis from a large, prospective study
| Autor: | Christopher L. Moore, Terrell Caffery, Vicki E. Noble, Christopher Raio, Jason T. Nomura, Anthony J. Weekes, Elke Platz, Daniel Theodoro, Samuel M. Brown, Michael Y. Woo, Margaret Lewis, Srikar Adhikari, Romolo Gaspari, Christine Haines, Otto Liebmann, David Blehar, Alexander T. Limkakeng, Paul Atkinson, Michael J. Lanspa, Samuel Lam |
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| Rok vydání: | 2021 |
| Předmět: |
medicine.medical_specialty
Electric Countershock Emergency Nursing Out of hospital cardiac arrest Electrocardiography Secondary analysis Internal medicine medicine Humans cardiovascular diseases Prospective Studies Asystole Prospective cohort study Fibrillation medicine.diagnostic_test business.industry Echo (computing) medicine.disease Cardiopulmonary Resuscitation Echocardiography Pulseless electrical activity Emergency Medicine Cardiology medicine.symptom Cardiology and Cardiovascular Medicine business Out-of-Hospital Cardiac Arrest |
| Zdroj: | Resuscitation. 169 |
| ISSN: | 1873-1570 |
| Popis: | Objective To measure prevalence of discordance between electrical activity recorded by electrocardiography (ECG) and myocardial activity visualized by echocardiography (echo) in patients presenting after cardiac arrest and to compare survival outcomes in cohorts defined by ECG and echo. Methods This is a secondary analysis of a previously published prospective study at twenty hospitals. Patients presenting after out-of-hospital arrest were included. The cardiac electrical activity was defined by ECG and contemporaneous myocardial activity was defined by bedside echo. Myocardial activity by echo was classified as myocardial asystole--the absence of myocardial movement, pulseless myocardial activity (PMA)--visible myocardial movement but no pulse, and myocardial fibrillation--visualized fibrillation. Primary outcome was the prevalence of discordance between electrical activity and myocardial activity. Results 793 patients and 1943 pauses in CPR were included. 28.6% of CPR pauses demonstrated a difference in electrical activity (ECG) and myocardial activity (echo), 5.0% with asystole (ECG) and PMA (echo), and 22.1% with PEA (ECG) and myocardial asystole (echo). Twenty-five percent of the 32 pauses in CPR with a shockable rhythm by echo demonstrated a non-shockable rhythm by ECG and were not defibrillated. Survival for patients with PMA (echo) was 29.1% (95%CI-23.9–34.9) compared to those with PEA (ECG) (21.4%, 95%CI–17.7–25.6). Conclusion Patients in cardiac arrest commonly demonstrate different electrical (ECG) and myocardial activity (echo). Further research is needed to better define cardiac activity during cardiac arrest and to explore outcome between groups defined by electrical and myocardial activity. |
| Databáze: | OpenAIRE |
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