• Jae Hwan Kim, Juncheol Lee, Hyungoo Shin, Tae Ho Lim, Bo-Hyoung Jang, Youngsuk Cho, Wonhee Kim, Kyu-Sun Choi, Jae Guk Kim, Chiwon Ahn, Heekyung Lee, Myeong Namgung, Min Kyun Na, and Sae Min Kwon.
• Department of Emergency Medicine, College of Medicine, Chung-Ang University, Seoul, Republic of Korea.
• Prehosp Emerg Care. 2024 Jun 3: 181-8.

ObjectiveRecent studies have shown inconsistent results regarding the association between QRS characteristics and survival outcomes in patients with cardiac arrest and pulseless electrical activity (PEA) rhythms. This meta-analysis aimed to identify the usefulness of QRS width and frequency as prognostic tools for outcomes in patients with cardiac arrest and PEA rhythm.MethodsExtensive searches were conducted using Medline, Embase, and the Cochrane Library to find articles published from database inception to 4 June 2023. Studies that assessed the association between the QRS characteristics of cardiac arrest patients with PEA rhythm and survival outcomes were included. The Newcastle-Ottawa Scale was used to assess the methodological quality of the included studies.ResultsA total of 9727 patients from seven observational studies were included in this systematic review and meta-analysis. The wide QRS group (QRS ≥ 120 ms) was associated with significantly higher odds of mortality than the narrow QRS group (QRS < 120 ms) (odds ratio (OR) = 1.86, 95% confidence interval (CI) = 1.11-3.11, I2 = 58%). The pooled OR for mortality was significantly higher in patients with a QRS frequency of < 60/min than in those with a QRS frequency of ≥ 60/min (OR = 1.90, 95% CI = 1.19-3.02, I2 = 65%).ConclusionsWide QRS width or low QRS frequency is associated with increased odds of mortality in patients with PEA cardiac arrest. These findings may be beneficial to guide the disposition of cardiac arrest patients with PEA during resuscitation.

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