Prognostic value of transient conduction disturbance in out-of-hospital cardiac arrest
Munehiro Iiya1, Masato Shimizu1, Shigeki Kimura1
1Department of Cardiology Yokohama Minami Kyosai Hospital Yokohama Japan.
Insights
Transient conduction disturbance on electrocardiograms after out-of-hospital cardiac arrest (OHCA) indicates a higher risk of 90-day mortality. This finding aids in predicting survival outcomes for OHCA patients who achieve return of spontaneous circulation.
Area of Science:
- Cardiology
- Emergency Medicine
- Clinical Research
Background:
- Out-of-hospital cardiac arrest (OHCA) remains a critical medical emergency with significant mortality.
- Electrocardiograms (ECGs) provide vital information for assessing cardiac events.
- Predicting mortality after OHCA is crucial for patient management and resource allocation.
Purpose of the Study:
- To investigate the impact of electrocardiograms (ECGs) on mortality following out-of-hospital cardiac arrest (OHCA).
- To determine if transient conduction disturbance (transient CD) on ECGs predicts 90-day mortality in OHCA survivors.
Main Methods:
- Retrospective observational study of 50 OHCA patients who achieved return of spontaneous circulation (ROSC) and survived ≥3 hours.
- Repeated 12-lead ECGs were analyzed: initial ECG post-ROSC and a second ECG after emergency department evaluation.
- Transient CD defined as QRS duration narrowing ≥18 ms between ECGs; multivariate Cox regression used to predict 90-day mortality.
Main Results:
- Among 50 OHCA patients, 30 survived for 90 days.
- Multivariate analysis identified transient CD and low-flow duration as significant predictors of all-cause mortality.
- Hazard ratios for transient CD and low-flow duration were 16.55 (P=0.001) and 1.06 (P=0.022), respectively.
Conclusions:
- Transient conduction disturbance is a powerful predictor of 90-day mortality in OHCA patients.
- ECG findings, specifically transient CD, can help stratify risk in survivors of out-of-hospital cardiac arrest.
- This study highlights the prognostic value of serial ECGs in post-OHCA care.
Aim:
A retrospective observational study to verify the impact of electrocardiograms (ECGs) following out-of-hospital cardiac arrest (OHCA) on mortality.
Methods:
We retrospectively studied 101 OHCA patients who achieved a return of spontaneous circulation (ROSC) and survived for ≥3 h. Among them, 50 patients (66 ± 17 years; 22 male) were evaluated using 12-lead ECGs repeatedly and were included in the final analysis: immediately after ROSC (initial ECG) and after the initial evaluation in the emergency department (second ECG). Transient conduction disturbance (transient CD) was defined as a narrowing in QRS duration from the initial to second ECG of ≥18 ms. Multivariate Cox regression analyses were carried out to predict 90-day mortality following OHCA.
Results:
Among 50 OHCA patients, 30 patients survived for 90 days. Thirty patients had initial ventricular fibrillation rhythm. Median emergency medical services response time and low-flow duration were 8 and 21 min, respectively. Multivariate analysis showed that the transient CD and low-flow duration were significant predictors of all-cause mortality (hazard ratio 16.55, 1.06; P = 0.001, 0.022, respectively).
Conclusion:
Transient CD is a powerful predictor of 90-day mortality in patients who survived 3 h after ROSC from OHCA.
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