ECG changes during resuscitation associate with return of spontaneous circulation

Gunnar Waage Skjeflo’s PhD thesis deals with electrocardiographic characteristics in cardiac arrest patients with initial pulseless electrical activity.


MAIN RESULTS:

  1. ECG changes associate with prognosis in in-hospital and out-of-hospital cardiac arrest with initial pulseless electrical activity.
  2. Intravenous adrenaline administration influences ECG changes during advanced life support.
  3. ECG changes before return of spontaneous circulation differ depending on the etiology of cardiac arrest.

THESIS DEFENCE:

Thesis: Development of Electrocardiographic Characteristics During Resuscitation from Pulseless Electrical Activity
Candidate: Gunnar Waage Skjeflo
Time: May 29, 2019 at 13:15
Place:St. Olavs Hospital, Medical Technical Research Center: Auditorium MTA
Link to university website (in Norwegian)


SUMMARY:

(1) Decreased QRS complex widths on electrocardiography are significantly more prevalent before return to spontaneous circulation following in-hospital cardiac arrest and pulseless electrical activity. A steady increase in heart rate during advanced life-support is also linked to better prognosis.

The study includes 2187 observations of patients with in-hospital cardiac arrest and initial pulseless electrical activity.

(3) The QRS complexes narrowed more before return to spontaneous circulation in patients with arrest of cardiac etiology. Heart rate development was similar regardless of etiology. In patients who did not return to spontaneous circulation, cardiac etiology was associated with wider QRS complexes.

The currently unpublished study includes 1844 ECG observations from a total of 63 patients with in-hospital cardiac arrest and pulseless electrical activity.

(2) Decreased QRS complex width and increasing heart rate are associated with return to spontaneous circulation also in out-of-hospital cardiac arrest with initial pulseless electrical activity. Intravenous adrenaline increased the heart rate also in patients that died, without a concomitant decrease in QRS complex.

The study includes 170 episodes of cardiac arrest and 4840 QRS width and heart rate observations. The patients included were part of a randomized controlled trial of advanced life support with or without intravenous adrenaline.


REFERENCES:

(1) Skjeflo, G. W., Nordseth, T., Loennechen, J. P., Bergum, D., & Skogvoll, E. (2018). ECG changes during resuscitation of patients with initial pulseless electrical activity are associated with return of spontaneous circulationResuscitation127, 31-36.

(2) Skjeflo, G. W., Skogvoll, E., Loennechen, J. P., Olasveengen, T. M., Wik, L., & Nordseth, T. (2019). The effect of intravenous adrenaline on electrocardiographic changes during resuscitation in patients with initial pulseless electrical activity in out of hospital cardiac arrestResuscitation136, 119-125.