• Resuscitation · Dec 2021

    Change in Out-of-Hospital 12-lead ECG Diagnostic Classification Following Resuscitation from Cardiac Arrest.

    • Tom P Aufderheide, Thomas W Engel, 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, and M Riccardo Colella.
    • Department of Emergency Medicine, Medical College of Wisconsin, Milwaukee, WI, USA. Electronic address: taufderh@mcw.edu.
    • Resuscitation. 2021 Dec 1; 169: 45-52.

    IntroductionWe 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.MethodsThis 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.ResultsFrom 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.ConclusionsChange 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.Copyright © 2021 Elsevier B.V. All rights reserved.

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