• Daniel Bergum, Gunnar Waage Skjeflo, Trond Nordseth, Ole Christian Mjølstad, Bjørn Olav Haugen, Eirik Skogvoll, and Jan Pål Loennechen.
• Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway; Department of Anaesthesia and Intensive Care Medicine, St. Olav University Hospital, Trondheim, Norway; Norwegian Air Ambulance Foundation, Norway. Electronic address: daniel.bergum@ntnu.no.
• Resuscitation. 2016 Jul 1; 104: 34-9.

IntroductionPulseless electrical activity (PEA) is an increasingly common presentation in cardiac arrest. The aim of this study was to investigate possible associations between early ECG patterns in PEA and the underlying causes and survival of in-hospital cardiac arrest (IHCA).MethodsProspectively observed episodes of IHCA presenting as PEA between January 2009 and august 2013, with a reliable cause of arrest and corresponding defibrillator ECG recordings, were analysed. QRS width, QT interval, Bazett's corrected QT interval, presence of P waves and heart rate (HR) was determined. QRS width and HR were considered to be normal below 120ms and within 60-100 cardiac cycles per minute, respectively.ResultsFifty-one episodes fulfilled the inclusion criteria. The defibrillator was attached after a median of one minute (75th percentile; 3min) after the onset of arrest. Ninety percent (46/51) had widened QRS complexes, 63% (32/51) were defined as 'wide-slow' due to QRS-widened bradycardia, and only 6% (3/51) episodes were categorized as normal. No unique cause-specific ECG pattern could be identified. Further 7 episodes with a corresponding defibrillator file, but without a reliable cause, were included in analysis of survival. Abnormal ECG patterns were seen in all survivors. None of the patients with 'normal' PEA survived.ConclusionAbnormal ECG patterns were frequent at the early stage of in-hospital PEA. No unique patterns were associated with the underlying causes or survival.Copyright © 2016 The Author(s). Published by Elsevier Ireland Ltd.. All rights reserved.

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