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

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Change in out-of-hospital 12-lead ECG diagnostic classification following resuscitation from cardiac arrest
Resuscitation ( IF 6.5 ) Pub Date : 2021-10-16 , DOI: 10.1016/j.resuscitation.2021.10.012
Tom P Aufderheide ₁ , Thomas W Engel ₂ , Hadi O Saleh ₁ , David D Gutterman ₃ , Benjamin W Weston ₂ , Paul E Pepe ₄ , John E Baker ₅ , Jacob Labinski ₁ , Guillaume Debaty ₆ , Lujia Tang ₇ , Aniko Szabo ₈ , Rajat Kalra ₉ , Demetris Yannopoulos ₉ , M Riccardo Colella ₂

Affiliation

Department of Emergency Medicine, Medical College of Wisconsin, Milwaukee, WI, USA.
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.
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.
Dallas County Emergency Medical Services and County Public Safety Agencies, Dallas, TX, USA.
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.
Department of Emergency Medicine, University Hospital of Grenoble Alps, University Grenoble Alps, France.
International Research Fellow, Department of Emergency Medicine, Medical College of Wisconsin, Milwaukee, WI, USA.
Division of Biostatistics, Medical College of Wisconsin, Milwaukee, WI, USA.
Division of Cardiology, Department of Medicine, University of Minnesota School of Medicine, Minneapolis, MN, USA.

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.

中文翻译：

心脏骤停复苏后院外 12 导联心电图诊断分类的变化

介绍

我们评估了院外 (OH) 心脏骤停 (OHCA) 复苏后患者连续 12 导联心电图 (ECG) 诊断分类变化的发生率，比较了 OH 和急诊科 (ED) 心电图。

方法

该回顾性病例系列包括：1) 成人（≥ 18 岁），2) 从 OHCA 中复苏，3) ≥ 1 OH 和 1 ED ECG/患者，以及 4) 紧急医疗服务 (EMS) 运送到研究医院。OH 和 ED ECG 被分类为：1) STEMI（ST 段抬高心肌梗死），2) 缺血性，和 3) 非缺血性。两名急诊科医生和一名心脏病专家对所有心电图进行独立分类，然后根据美国心脏协会 2018 年专家共识标准为每个心电图生成共识意见分类。将最缺血性的 OH ECG 分类与最后的 ED ECG 分类进行比较。

结果

从 2012 年 7 月 27 日到 2019 年 7 月 18 日，共有 176 名患者入组，平均年龄为 61.2 ± 16.6 岁；102/176 (58%) 是男性。总体而言，获得了 504 个 OH 和 ED 12 导联 ECG（2.9 个 ECG/患者）。心电图分类评分者间可靠性 kappa 分数为 0.63 ± 0.02（基本一致）。总体而言，86/176 (49%) 将 ECG 分类从 OH 更改为 ED 设置；这些 ECG 中有 69/86 (80%) 从更多的缺血性分类变为更少的缺血性分类。在 49 项 OH STEMI ECG 分类中，33/49 (67%) 变为缺血性较低（非 STEMI）ED ECG 分类。